Annals of Surgery

Skip Navigation LinksHome > September 2009 - Volume 250 - Issue 3 > Small-Incision Mitral Valve Repair: Safe, Durable, and Appro...
Annals of Surgery:
doi: 10.1097/SLA.0b013e3181b39898
Original Articles

Small-Incision Mitral Valve Repair: Safe, Durable, and Approaching Perfection

Gammie, James S. MD; Bartlett, Stephen T. MD; Griffith, Bartley P. MD

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Objective: To critically evaluate an initial experience with small-incision mitral valve operation with respect to safety, durability, and effectiveness.

Summary Background Data: Mitral valve (MV) surgery is dominated by a sternotomy approach, with MV repair rates which average 60%. Advantages of valvular repair compared with replacement include lower operative and long-term mortality, decreased stroke and infection risks, and superior freedom from reoperation and complications of anticoagulation.

Methods: Right chest small-incision MV surgery was performed on 187 consecutive patients. Outcomes including operative mortality and major morbidity were recorded. All patients underwent predismissal echocardiography in a core laboratory.

Results: Between 2003 and 2008, 57% (187/327) of isolated MV operations were performed using an anterolateral 6 cm 4th intercostal space small-incision. Operative techniques included femoral arterial and venous plus internal jugular cannulation and direct aortic cross-clamping. Pathology of the anterior leaflet was present in 22%, and PTFE neochordal repairs were used in 36% of cases. The rate of MV repair was 96.3% (180/187) and was 100% for patients with degenerative disease. Median cardiopulmonary bypass and aortic cross-clamp times were 108 and 82 minutes, respectively. There were no deaths, strokes, renal failure, or wound infections. Two patients (1.1%) were re-explored for bleeding, and 27% received blood transfusions. The median hospital stay was 4 days. Clinical core laboratory-assessed freedom from significant (MR > mild) at hospital discharge was 99%. Survival at a median follow-up of 2.5 years was 99%.

Conclusions: Direct visualization of the mitral valve through a right chest small-incision enables safe and effective performance of complex MV repair, with repair rates in excess of 95%.

© 2009 Lippincott Williams & Wilkins, Inc.


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