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

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

doi: 10.1097/SLA.0b013e3181b39898
Original Articles

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%.

Right chest small-incision mitral valve surgery was performed on 187 consecutive patients between 2003 and 2008. The rate of mitral valve repair was 96% and was 100% for patients with degenerative disease. There were no deaths, strokes, renal failure, or wound infections, and the median length of stay was 4 days.

From the Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.

Presented at the 129th Annual Meeting of the American Surgical Association, Indian Wells, California, April 23–25, 2009.

Reprints: James S. Gammie, MD, Division of Cardiac Surgery, University of Maryland Medical Center, N4W94, 22 South Greene Street, Baltimore, MD 21201; E-mail: jgammie@smail.umaryland.edu.

© 2009 Lippincott Williams & Wilkins, Inc.