MINIMALLY INVASIVE SURGERY FOR ISOLATED MITRAL VALVE DISEASE: A SINGLE CENTER 5–YEAR EXPERIENCE

Abstract Introduction Minimally invasive surgery (MIS) has become the standard of care in our department to address mitral valve diseases (MVD). We nowadays use the mini–thoracotomy approach independently of the MVD etiology and for both complex and simple lesions (posterior leaflet prolapse). The aim of this study was to analyze the efficacy of the approach by observing also post–operative results. Methods We retrospectively analyzed 484 patients who consecutively underwent mitral valve surgery with a minimal invasive approach from January 1st 2018 to December 31st 2022. The patients included in the study were addressed to surgery for a mainly mitral valve pathology (regurgitation, stenosis, prosthesis disfunction). All of the interventions were executed by the same surgeon. We performed a minithoracotomy at the III or IV intercostal space, depending on the anatomy of the patient, always assisted by an endoscopic camera. When necessary, we used periareolar thoracotomy or axillary approach. In the latter without assistance of the camera. The patients had a 3–month follow up visit at least and the longest follow–up monitoring was at five years. Results Overall repair rate was 90% (±3%) which increased to 96% (±1%) when we analyzed the repair rate for degenerative mitral valve pathology as unique etiology. 48% of the mitral valve insufficiency was related to posterior leaflet prolapse and among them 63% had an isolated lesion of of P2 scallop. Hospital stay was 10 days that turned to 6 days when we excluded patients with transitory complications. Conclusions MIS for isolated mitral valve disease provided a good repair rate even in complex anatomy. We also observed good results for mitral valve replacement, deemed necessary in non–degenerative etiologies. A good exposure of the valve, then, permits to address the great majority of the MVD avoiding the longer hospital stay needed after median sternotomy and guarantees a faster return to work without rib fracture implying excellent pain control.