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. 2023 Aug 18;18(1):248.
doi: 10.1186/s13019-023-02352-9.

Mid-term results of endoscopic mitral valve repair and insights in surgical techniques for isolated posterior prolapse

Enrico Squiccimarro  1   2 , Vito Margari  3 , Georgios Kounakis  3 , Giuseppe Visicchio  3 , Clemente Pascarella  3   4 , Crescenzia Rotunno  3 , Carmine Carbone  3 , Domenico Paparella  5   6
Affiliations

Mid-term results of endoscopic mitral valve repair and insights in surgical techniques for isolated posterior prolapse

Enrico Squiccimarro et al. J Cardiothorac Surg. .

Abstract

Background: The adoption of minimally invasive techniques to perform mitral valve repair surgery is increasing. This is enhanced by the compelling evidence of satisfactory short-term results and lower major morbidity. We analyzed mid-term follow-up results of our experience, and further compared two techniques: isolated leaflet resection and neochord implantation for posterior leaflet prolapse.

Methods: Data for all consecutive endoscopic mitral valve repairs via video-assisted right anterior mini-thoracotomy were analyzed between December 2012 and September 2021. The early and mid-term follow-up results were ascertained. The main outcome was the incidence of mortality and the recurrence of significant mitral regurgitation during follow-up which were summarized by the Kaplan-Meier estimator and compared between treatment arms using the stratified log-rank test. Secondary outcomes were the early-postoperative results including 30-days mortality and the occurrence of major complications.

Results: A total of 309 patients were included. Along with ring annuloplasty, 136 (44.4%) patients received posterior leaflet resection (122 isolated) whereas 97 (31.1%) underwent posterior leaflet chords implantation (88 isolated). Forty-nine patients had annuloplasty alone. In-hospital mortality was 1.0%. Mean follow-up was 28.8 ± 22.0 months (maximum 8.3 years). Kaplan-Meier survival rate at 5 years was 97.3 ± 1.0%, mitral regurgitation ([Formula: see text]3+) or valve reoperation free-survival at 5 years was estimated as 94.5 ± 2.3%. Subgroup time-to-event analysis for the indexed outcomes showed no statistical significance between the techniques.

Conclusions: Endoscopic mitral valve repair is safe and associated with excellent short- and mid-term outcomes. No differences were found between leaflet resection and gore-tex chords implantation for posterior leaflet prolapse.

Keywords: Endoscopic mitral valve repair; Long-term results; Minimally invasive cardiac surgery.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Periareolar approach: incision (Panel A), set-up (Panel B), final result (Panel C)
Fig. 2
Fig. 2
Kaplan-Meier analysis of long-term overall mortality (Panel A), and freedom from MV reoperation or MR ≥ 3+ (Panel B)
Fig. 3
Fig. 3
Subgroup Kaplan-Meier analysis for overall survival at follow-up (Panel A), and freedom from MV reoperation or MR ≥ 3 + at follow-up (Panel B)
See this image and copyright information in PMC

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References

    1. Bowdish ME, D’Agostino RS, Thourani VH, Schwann TA, Krohn C, Desai N, et al. STS adult cardiac surgery database: 2021 update on outcomes, Quality, and Research. Ann Thorac Surg. 2021;111(6):1770–80. doi: 10.1016/j.athoracsur.2021.03.043. - DOI - PubMed
    1. Nissen AP, Miller CC, Thourani VH, Woo YJ, Gammie JS, Ailawadi G, et al. Less invasive mitral surgery Versus Conventional Sternotomy Stratified by Mitral Pathology. Ann Thorac Surg. 2021;111(3):819–27. doi: 10.1016/j.athoracsur.2020.05.145. - DOI - PubMed
    1. Paparella D, Fattouch K, Moscarelli M, Santarpino G, Nasso G, Guida P et al. Current Trends in Mitral Valve surgery: a Multicenter National comparison between full-sternotomy and minimally-invasive Approach. Int J Cardiol. 2019;306. - PubMed
    1. Holzhey DM, Seeburger J, Misfeld M, Borger MA, Mohr FW. Learning minimally invasive mitral valve surgery. Circulation. 2013;128(5):483–91. doi: 10.1161/CIRCULATIONAHA.112.001402. - DOI - PubMed
    1. Grant SW, Hickey GL, Modi P, Hunter S, Akowuah E, Zacharias J. Propensity-matched analysis of minimally invasive approach versus sternotomy for mitral valve surgery. Heart. 2018;105(10):783–9. doi: 10.1136/heartjnl-2018-314049. - DOI - PubMed