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Strategy-specific durability of mitral valve repair through the video-assisted right minithoracotomy approach

Agnino, Alfonsoa,b; Antonazzo, Andreaa,b; Albano, Giovannic; Panisi, Paoloa; Gerometta, Piersilvioa; Piti, Antoninoa; Anselmi, Amedeod

Journal of Cardiovascular Medicine: March 2019 - Volume 20 - Issue 3 - p 137–144
doi: 10.2459/JCM.0000000000000753
Research articles: Cardiac surgery

Aims We sought to analyze the early and follow-up results of minimally invasive video-assisted mitral valve repair. With particular focus on degenerative disease, results were stratified according to type of lesion, strategy of repair and surgical technique.

Methods We retrospectively built a database over 241 patients who received mitral repair for severe regurgitation through right minithoracotomy in the 2009–17 period. Cause was degenerative in 92.1%, restrictive in 5.8% and mixed in the remainders. Clinical and echocardiographic follow-up (98.7% complete, average duration 2.9 years ± 1.4) was obtained through contact of in-house and territorial cardiologists. Recurrent mitral regurgitation at follow-up was defined as being at least mild-to-moderate (2+).

Results Operative mortality was 1.7%, and related to the technique in one case. Five-year actuarial survival was 95% ± 2; there was no valve-related death and one reoperation. At follow-up, we observed eight cases of 2+ regurgitation and one instance of 4+ regurgitation (4-year actuarial freedom: 92% ± 4). Freedom from recurrent regurgitation was significantly lower in the ‘restrictive’ subgroup vs. the ‘degenerative’ subgroup (P = 0.02); no statistically significant difference in freedom from recurrence was observed among patients who received mitral repair using a ‘resect’ vs. ‘nonresection’ strategy (P = 0.46), and in those who received the Totally Endoscopic technique (endoaortic balloon occlusion, no costal spreading) vs. controls (external aortic clamp, costal spreading) (P = 0.98).

Conclusion Durability of minimally invasive mitral repair is optimal. Nonresection repair techniques are at least noninferior to previous approaches based on leaflet resection.

aCardiovascular Department

bDivision of Minimally Invasive Cardiac Surgery

cDivision of Cardiac Anesthesia, Cliniche Humanitas Gavazzeni, Bergamo, Italy

dDivision of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France

Correspondence to Amedeo Anselmi, MD, PhD, Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, 2 Rue Henri Le Guilloux, 35000 Rennes, France Tel: +00 33 299282496; fax: +00 33 299282416; e-mail:

Received 24 April, 2018

Revised 3 October, 2018

Accepted 9 December, 2018

© 2019 Italian Federation of Cardiology. All rights reserved.