Mid-term results of endoscopic mitral valve repair and insights in surgical techniques for isolated posterior prolapse

Journal of Cardiothoracic Surgery

Research

Enrico Squiccimarro¹  Domenico Paparella²  Giuseppe Visicchio³  Georgios Kounakis³  Carmine Carbone³  Crescenzia Rotunno³  Vito Margari³  Clemente Pascarella⁴ 

[1] Division of Cardiac Surgery, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto Luigi, 251, 71122, Foggia, Foggia, Italy;Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands;Division of Cardiac Surgery, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto Luigi, 251, 71122, Foggia, Foggia, Italy;Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy;Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy;Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy;Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy;

关键词: Endoscopic mitral valve repair;    Minimally invasive cardiac surgery;    Long-term results;   

DOI  :  10.1186/s13019-023-02352-9

 received in 2022-12-20, accepted in 2023-08-09,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe adoption of minimally invasive techniques to perform mitral valve repair surgery is increasing. This is enhanced by the compelling evidence of satisfactory short-term results and lower major morbidity. We analyzed mid-term follow-up results of our experience, and further compared two techniques: isolated leaflet resection and neochord implantation for posterior leaflet prolapse.MethodsData for all consecutive endoscopic mitral valve repairs via video-assisted right anterior mini-thoracotomy were analyzed between December 2012 and September 2021. The early and mid-term follow-up results were ascertained. The main outcome was the incidence of mortality and the recurrence of significant mitral regurgitation during follow-up which were summarized by the Kaplan-Meier estimator and compared between treatment arms using the stratified log-rank test. Secondary outcomes were the early-postoperative results including 30-days mortality and the occurrence of major complications.ResultsA total of 309 patients were included. Along with ring annuloplasty, 136 (44.4%) patients received posterior leaflet resection (122 isolated) whereas 97 (31.1%) underwent posterior leaflet chords implantation (88 isolated). Forty-nine patients had annuloplasty alone. In-hospital mortality was 1.0%. Mean follow-up was 28.8 ± 22.0 months (maximum 8.3 years). Kaplan–Meier survival rate at 5 years was 97.3 ± 1.0%, mitral regurgitation (\documentclass[12pt]{minimal}\usepackage{amsmath}\usepackage{wasysym}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{amsbsy}\usepackage{mathrsfs}\usepackage{upgreek}\setlength{\oddsidemargin}{-69pt}\begin{document}$$\ge$$\end{document}3+) or valve reoperation free-survival at 5 years was estimated as 94.5 ± 2.3%. Subgroup time-to-event analysis for the indexed outcomes showed no statistical significance between the techniques.ConclusionsEndoscopic mitral valve repair is safe and associated with excellent short- and mid-term outcomes. No differences were found between leaflet resection and gore-tex chords implantation for posterior leaflet prolapse.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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