Midterm Outcomes after Minimally Invasive Mitral Valve Surgery through a Right Anterior Minithoracotomy over 75 Years of Age

Objectives: In this single center study we aim to report outcomes after minimally invasive mitral valve surgery in patients older than 75 years of age.

Methods: Retrospective analysis of patients 75 years or older who underwent minimal invasive mitral valve surgery through a right anterior mini-thoracotomy between 2009 and 2014.

Results: 75 patients were identified. Mean age was 79.2 ± 3.1 years and 48% were men. Degenerative mitral regurgitation was the most frequent underlying etiology (44%). Mean EuroSCORE was 7.3 (range 2–13). Mean preoperative left ventricular ejection fraction (EF) was 60.5% ± 10.4. Isolated mitral surgery was performed in 51%. In 78% (59 patients) mitral repair was achieved. There were no in-hospital deaths. Median follow-up was 36 months and 2 (2.7%) patients were lost to follow-up. Overall mortality was 20% and four (5.3%) patients died from cardiac reasons. Survival at 12 and 40 months was 93.4% and 80%, respectively. One patient (1.3%) required mitral valve replacement 10 months after surgery. Major adverse cardiac and cerebrovascular events (MACCE) occurred in 2.7% (2 patients). At echocardiographic follow up 87% (46/53) of the mitral repairs remained stable (MR≤2+). 94% of all patients remained asymptomatic (NYHA≤2).

Conclusion: Minimally invasive mitral valve surgery through a right anterior mini-thoracotomy in elderly patients over 75 years of age is safe and offers stable mid-term results. High repair rates combined with high freedom of MACCE and reoperation is feasible with minimal invasive mitral valve surgery in this elderly population.