Mid-term echocardiographic and clinical follow-up after minimally invasive mitral valve surgery through a right mini-thoracotomy

Objective: To examine the mid-term results of minimal invasive mitral valve (MV) surgery by telephone interview and echocardiographic follow-up.

Material and methods: From October 2001 to November 2006, 56 patients (20 females, median age 52 years) underwent video-assisted, minimally invasive MV-surgery through a right anterior mini-thoracotomy. Patients were followed-up (mean follow-up 40±17 months) by telephone interview (n=51) and by echocardiography (n=42). The underlying diseases were MV-insufficiency (n=52), MV-stenosis (n=1) and combined MV-disease (n=3). Reconstructions were performed in 91% (n=51), MV replacement in 9% (n=5). Mean preoperative New York Heart Association functional class (NYHA) was 2.1±0.94. Additionally tricuspid valve repair (n=1), ASD closure (n=1) and atrial ablation (n=4) were performed.

Results: Thirty-day mortality was 0%. The over-all survival rate at follow-up was 98%. During follow-up patients developed inguinal lymph fistula (n=2), thoracic wall hernias (n=2) and wound infection (n=1). Mean NYHA class at follow-up was 0.6±0.7. Echocardiographic follow-up documented regular valve function in 39 patients (93%). After MV-reconstruction 92% (n=36) showed MV regurgitation degree ≤1. Only 3 patients (8%) showed moderate regurgitation degree 2. Mean gradient was <5mm Hg in 90% and <10mmHg in 10%. One patient, diagnosed with an antiphospholipid syndrome, developed MV stenosis after reconstruction and underwent reoperation 26 months postoperatively. There were no valve related complications such as bleeding or endocarditis. Two patients suffered from stroke (late events) of whom one died.

Conclusion: Mitral valve operation through a right mini-thoracotomy is a safe procedure allowing accurate MV repair in most cases and very good midterm results.