Minimally Invasive Nonresectional Mitral Valve Repair Long-term Results

• Published in: Canadian journal of cardiology 2023-07, Vol.39 (7), p.990-996
• Main Authors: Berdajs, Denis, Miazza, Jules, Koechlin, Luca, Gahl, Brigita, Reuthebuch, Oliver, Eckstein, Friedrich
• Format: Article
• Language: English
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2023.03.027

We aimed to assess the outcomes of the minimally invasive nonresectional technique over 10 years in patients with severe mitral valve insufficiency. 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. 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. 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. Cette étude visait à évaluer les résultats de la technique de réparation minimalement invasive sans résection chez des patients présentant une insuffisance mitrale grave sur une période de 10 ans. Une analyse rétrospective de 365 patients atteints d’insuffisance mitrale ayant subi une réparation endoscopique minimalement invasive complète de la valve mitrale a été effectuée entre mai 2009 et septembre 2021. Tous les patients ont été traités par la technique de réparation sans résection utilisant l’implantation artificielle de néocordages ou une annuloplastie par anneau. Des suivis cliniques et échocardiographiques ont été réalisés. L’intervention minimalement invasive a été réalisée avec succès chez tous les patients. L’âge moyen des patients était de 61 ± 11 ans, et 36 % étaient des femmes. Le taux de réussite