# Comparison of Left Ventricular Functional Recovery and Remodeling After Total Thoracoscopic Mitral Valve Repair and Replacement in Patients With Mitral Regurgitation and Mildly to Moderately Reduced Left Ventricular Ejection Fraction

## TL;DR

This study compares heart function recovery after two minimally invasive mitral valve surgeries in patients with reduced heart function, finding that repair leads to better outcomes than replacement.

## Contribution

The study provides new evidence on the superior short-term left ventricular recovery with mitral valve repair over replacement in high-risk patients.

## Key findings

- TT-MVr resulted in higher LVEF and smaller LV dimensions compared to TT-MVR at 3 and 6 months.
- Both TT-MVr and TT-MVR improved NYHA functional class within 6 months.
- TT-MVr is associated with better LV functional recovery and remodeling in patients with reduced LVEF.

## Abstract

Background: Total thoracoscopic mitral valve surgery (TT-MVS) is a minimally invasive technique for mitral regurgitation (MR), but its impact on left ventricular (LV) function and remodeling in patients with reduced LV ejection fraction (LVEF) is unclear.

Methods: We retrospectively compared 94 patients who underwent total thoracoscopic mitral valve repair (TT-MVr) or total thoracoscopic mitral valve replacement (TT-MVR) for MR and reduced LVEF at our center from January 1, 2017, to December 31, 2022. We assessed LV functional recovery and remodeling by echocardiography at baseline, 1 week, 3 months, and 6 months after surgery.

Results: A total of 43 patients underwent TT-MVr and 51 patients underwent TT-MVR. Both groups had similar early outcomes, hospital mortality, and postoperative complications. The TT-MVr group had higher LVEF and lower left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) than the TT-MVR group at 3 and 6 months after surgery (p < 0.05 for all comparisons). Both groups improved in New York Heart Association (NYHA) functional class from baseline to 6 months after surgery (p < 0.05 for all comparisons).

Conclusion: TT-MVr and TT-MVR are feasible and safe for patients with MR and reduced LVEF, but TT-MVr is associated with better LV functional recovery and remodeling within 6 months after surgery. TT-MVr should be preferred over TT-MVR whenever possible in this high-risk population. Further studies are needed to evaluate the long-term outcomes of TT-MVS in this population.