# Efficacy and Outcomes of Para-Annular Plication in Mitral Valve Repair via Right Mini-Thoracotomy

## TL;DR

This study shows that using a minimally invasive approach with para-annular plication during mitral valve repair is safe and effective, with outcomes similar to traditional methods.

## Contribution

The study introduces the use of right mini-thoracotomy with para-annular plication for mitral valve repair as a viable alternative to conventional approaches.

## Key findings

- No 30-day mortality or hospitalization-related deaths were observed in either group.
- Both groups showed comparable reductions in left atrial diameter and volume index post-surgery.
- The three-year survival rates were similar between the conventional and minimally invasive groups.

## Abstract

Purpose: We aim to assess the efficacy and safety of left atrial plication (LAP), particularly para-annular plication, using a right mini-thoracotomy approach.

Methods: Among 90 mitral valve repair (MVr) procedures performed at our institution between 2016 and 2023, 16 left atrial plication cases for left atrial enlargement (diameter: >50 mm) were assessed; nine cases underwent median sternotomy (conventional) (Group C), and seven cases underwent minimally invasive cardiac surgery (MICS) (Group M). The surgical protocol involved mitral valve repair via a right-sided left atrial approach, incorporating para-annular plication to suture the posterior wall. The mean follow-up duration was 3.3±2.4 years.

Results: Mortality within 30 days of surgery or during hospitalization did not occur. Postoperative complications included one case in each group that required reoperation for hemorrhage originating extraneously in the left atrium. Postoperative echocardiographic assessments revealed a comparable reduction in left atrial diameter (C/M: 80.3±7.0/80.7±14.6%; p=0.94), left atrial volume index (55.6±19.3/68.3±34.1%; p=0.36), and aorto-mitral angle (AMA) enlargement (113.8±7.3/107.5±12.2%; p=0.22). The three-year survival rate (88.9%/75.0%; p=0.33) was comparable between groups.

Conclusion: The synergistic utilization of left atrial plication with para-annular plication via right mini-thoracotomy can enhance the postoperative outcomes of mitral valve repair.