Minimally Invasive Nonresectional Mitral Valve Repair Long-term Results

Abstract

Background: We aimed to assess the outcomes of the minimally invasive nonresectional technique over 10 years in patients with severe mitral valve insufficiency.

Methods: A retrospective analysis of 365 patients undergoing a minimally invasive complete endoscopic mitral valve repair for mitral valve insufficiency was conducted between May 2009 and September 2021. All patients underwent the nonresectional repair approach using artificial neochordae implantation or ring annuloplasty. Clinical and echocardiographic follow-ups were performed.

Results: The minimal invasive procedure was successfully performed in all patients. The mean age was 61 ± 11, and 36% were female patients. The surgical success was 99.7%, with no conversion to sternotomy or to mitral valve replacement at 30 days. In 1 case (0.27%), mitral valve related reoperation was performed during the hospital stay. The procedural safety was 92%, with in-hospital mortality in 0.55% (n = 2), stroke in 0.55% (n = 2), and perioperative myocardial infarction in 0.82% (n = 3) patients. The mean follow up was 5.3 ± 2.9 years. Survival at 5 and 10 years was 96% (95% confidence interval [CI], 94%-98%) and 83% (95% CI, 72%-90%). Freedom of myocardial infarction, stroke, and congestive heart failure at 10 years was 95% (95% CI, 88%-98%), 86% (95% CI, 75%-92%), and 93% (95% CI, 89%-96%), respectively. Recurrent mitral valve insufficiency ≥ + 2 was diagnosed in 4.9% of cases.

Conclusions: Minimally invasive nonresectional mitral valve repair technique can be performed for severe mitral valve regurgitation with excellent long-term results. The procedure is safe, with minimal risk of reoperation and recurrent mitral valve insufficiency at long term.