Five Years of Less Invasive Mitral Valve Surgery: From Experimental to Routine Approach

Abstract

Background: In the last five years, mitral valve surgery has changed fundamentally. This study reviews our experience in less invasive mitral valve surgery (LIMS) during that time.
Methods: LIMS was performed in 449 patients (age 59 ± 14 years, 237 female) via a right lateral minithoracotomy. The operations included 42 “redo” procedures. After initially experiencing a high number of complications, we have modified and simplified the procedure. After using the Port-Access™ Technique (PAT) in the earlier stages of our series, in the last 226 patients the aorta was clamped directly using the transthoracic clamping (Chitwood) technique (TTC). In our most recent cases, PAT was only employed in redo procedures. In 336 patients, the procedure was completed with robotic assistance, and in 23 of these we used the da Vinci telemanipulation system.
Results: The mitral valve was repaired in 327 patients and replaced in 122 patients. In 100 patients, additional surgical procedures (TVR n = 13, ASD closure n = 16, left atrial ablation n = 65, left atrial reduction plasty n = 6) were performed. Bypass and clamp time, including times for both additional and redo procedures, were 124 ± 44 min. and 65 ± 29 min. in the overall series. Complications, which were mainly neurological, were fewer in the TTC group than in the PAT group (n = 4 vs. n = 17; p <0.04). Hospital mortality was 3.1% and 5.2%, respectively, for the two groups. There were no additional costs associated with using the TTC technique compared to conventional procedures. Mean survival rate was 96.3% at a mean follow-up of 727 ± 451 days (95% CI, 677 to 779).
Conclusions: Less invasive mitral valve surgery enables the patient to avoid the surgical trauma associated with sternotomy. It has developed into a reliable technique with reproducible results for primary, redo, and additional procedures. LIMS has become the standard approach for mitral valve operations at our institution.