Minimally Invasive Mitral Valve Surgery: Long-Term (20-Year) Follow-Up After Right Anterolateral Minithoracotomy

TL;DR

This study shows that minimally invasive mitral valve surgery has good long-term outcomes and low mortality over 20 years.

Contribution

The paper provides long-term (up to 21.6 years) follow-up data on minimally invasive mitral valve surgery outcomes.

Findings

The 20-year survival rate was 55.0% ± 4%.

The cumulative incidence of reoperation at 20 years was 7.0% ± 1.6%.

The 30-day mortality rate was 3.3% with low perioperative complications.

Abstract

Minimally invasive mitral valve (MV) surgery (MIMVS) through right lateral minithoracotomy has evolved as the standard approach for most patients. Data on long-term functional outcomes, however, are rare. We evaluated long-term outcomes after MIMVS through right minithoracotomy for up to 21.6 years.

From 1997 to 2017, 301 patients with a median age of 57 years (range, 20-81; 54.5% female) underwent MIMVS through right anterolateral minithoracotomy. Follow-up data were evaluated using Kaplan–Meier analyses and competing risk analysis.

A total of 249 patients (82.7%) underwent MV repair, and 52 (17.2%) received valve replacement. Conversion to sternotomy was required in 2 patients (0.8%), and 2 patients (0.8%) suffered perioperative stroke. The 30-day mortality rate was 3.3%. During follow-up, 21 patients required MV reoperation after a mean period of 21.6 ± 0.2 years. The cumulative incidence of reoperation at 5, 10, 15, and 20 years, respectively, was 2.0% ± 0.8%, 4.5% ± 1.2%, 6.0% ± 1.4%, and 7.0% ± 1.6%. The cumulative incidence of recurrent mitral regurgitation ≥ moderate at 5, 10, 15, and 20 years, respectively, was 4.5% ± 1.2%, 11.1% ± 1.9%, 16.4% ± 2.2%, and 20.2% ± 2.7%. The 10- and 20-year survival of all patients was 83.6% ± 2% and 55.0% ± 4%, respectively.

MIMVS can be performed safely with very good perioperative outcomes, a low incidence of mortality, and excellent long-term valve performance.

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