Small-incision Mitral Valve Repair: Safe, Durable, and Approaching Perfection
*James S Gammie, Stephen T Bartlett, Bartley P Griffith
University of Maryland Medical Center, Baltimore, MD
Mitral valve (MV) surgery in the USA is dominated by a sternotomy approach, with average repair rates of 60%. Advantages of mitral repair compared to replacement include lower operative and long-term mortality, decreased stroke and infection risks, and superior freedom from reoperation and complications of anticoagulation. This study examines results of right chest small-incision MV surgery at a single center.
Right chest small-incision MV surgery was performed on 169 consecutive patients. All patients underwent predismissal echocardiography in a core laboratory.
Between 2003 and 2008, 39% (169/437) of isolated MV operations were performed using a 6 cm 4th intercostal space small-incision approach. Operative techniques included femoral cannulation and transthoracic cross clamping. Anterior leaflet pathology was present in 33%, and PTFE neochordal repairs were used in 34% of cases. The MV repair rate was 95 % (161/169). Median cardiopulmonary bypass and aortic cross clamp times were 110 and 84 minutes, respectively. There were no deaths, strokes, renal failure, or wound infections. Two patients (1.2 %) were re-explored for bleeding, and 27 % received blood transfusions. The median hospital stay was 4 days. Freedom from significant (MR > mild) was 99%. Survival at a median follow-up of 2.2 years was 100 %. One patient required reoperation 4 ½ years after MV repair for rheumatic disease.
Direct visualization of the mitral valve through a right chest small-incision enables safe and effective performance of complex MV repair. The evolving technical aspects of this approach will be discussed.