Is Minimally Invasive Mitral Valve Surgery Possible in Complex Patients?

pp. 314-319

Abstract

Background: Patients at high risk of preoperative morbidity and mortality, mitral valve endocarditis or prior cardiac surgery are considered “limiting” cases to undergo minimally invasive cardiac surgery.

Objectives: The aim of this study was to assess the outcome of complex patients undergoing minimally invasive surgery. The primary endpoint was post-operative mortality at 30 days and the secondary endpoint was the analysis of technical-surgical
results and early postoperative complications.

Methods: The study consisted in the retrospective analysis of mitral valve surgeries performed at Hospital Italiano de Buenos Aires from January 2010 to April 2016. A total of 135 mitral valve surgeries, 63 by minimally invasive technique (46.6%) were performed. Forty-five patients (71.4%) were considered as “complex”, including those with >10% STS-PROMM risk, active endocarditis, or prior cardiac surgery.

Results: Surgeries were elective in 73.3% of cases (n=33), urgent in 22.2% (n=10) and emergent in 4.4% (n=2). Percent STS PROM and %STS-PROMM were 6.08±10.8 and 26.7±16.8, respectively. Six patients with prior cardiac surgery and 5 with endocarditis in active treatment were included. Mitral valve replacement (14 rheumatic) was performed in 62% of patients (n=28) and mitral valve repair in 38% (n=17). No deaths were registered in mitral valve repair or mediastinitis. Mortality at 30 days was 4.4% (n=2) and conversion to sternotomy was necessary in one case.

Conclusions: The observed mortality is lower than the one calculated by the risk score (%STS-PROMM 6.08±10.8 vs. 4.4). The right video-assisted minithoracotomy offered excellent exposure and interpretation of the disease. The minimally invasive surgical technique can be used in patients with prior cardiac surgery, endocarditis and/or patients with a high preoperative risk score.