Minimally Invasive Mitral Valve Surgery: Long-Term (20-Year) Follow-Up After Right Anterolateral Minithoracotomy

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-07-01 DOI:10.1016/j.cjco.2025.02.001

Razan Salem MD , Katharina Fay MD , Philipp Kaiser MD , Afsaneh Karimian-Tabrizi , Eva Herrmann PhD , Andreas Winter MD , Jan Hlavicka MD, PhD , Florian Hecker MD , Anton Moritz MD , Thomas Walther MD , Tomas Holubec MD, PhD

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Abstract

Background

Minimally invasive mitral valve (MV) surgery (MIMVS) through right lateral minithoracotomy has evolved as the standard approach for most patients. Data on long-term functional outcomes, however, are rare. We evaluated long-term outcomes after MIMVS through right minithoracotomy for up to 21.6 years.

Methods

From 1997 to 2017, 301 patients with a median age of 57 years (range, 20-81; 54.5% female) underwent MIMVS through right anterolateral minithoracotomy. Follow-up data were evaluated using Kaplan–Meier analyses and competing risk analysis.

Results

A total of 249 patients (82.7%) underwent MV repair, and 52 (17.2%) received valve replacement. Conversion to sternotomy was required in 2 patients (0.8%), and 2 patients (0.8%) suffered perioperative stroke. The 30-day mortality rate was 3.3%. During follow-up, 21 patients required MV reoperation after a mean period of 21.6 ± 0.2 years. The cumulative incidence of reoperation at 5, 10, 15, and 20 years, respectively, was 2.0% ± 0.8%, 4.5% ± 1.2%, 6.0% ± 1.4%, and 7.0% ± 1.6%. The cumulative incidence of recurrent mitral regurgitation ≥ moderate at 5, 10, 15, and 20 years, respectively, was 4.5% ± 1.2%, 11.1% ± 1.9%, 16.4% ± 2.2%, and 20.2% ± 2.7%. The 10- and 20-year survival of all patients was 83.6% ± 2% and 55.0% ± 4%, respectively.

Conclusions

MIMVS can be performed safely with very good perioperative outcomes, a low incidence of mortality, and excellent long-term valve performance.

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微创二尖瓣手术：右前外侧小开胸术后长期（20年）随访

背景：通过右外侧小开胸的微创二尖瓣手术（MIMVS）已经发展成为大多数患者的标准入路。然而，关于长期功能结果的数据很少。我们通过右小开胸术评估MIMVS术后长达21.6年的长期结果。方法1997 - 2017年，301例中位年龄57岁的患者(范围20-81；54.5%女性)通过右前外侧小开胸行MIMVS。采用Kaplan-Meier分析和竞争风险分析对随访数据进行评价。结果249例（82.7%）行中压修复，52例（17.2%）行瓣膜置换术。2例（0.8%）患者需要转换为胸骨切开术，2例（0.8%）患者发生围手术期卒中。30天死亡率为3.3%。在随访中，21例患者在平均21.6±0.2年后需要再手术。5年、10年、15年、20年的再手术累计发生率分别为2.0%±0.8%、4.5%±1.2%、6.0%±1.4%、7.0%±1.6%。5年、10年、15年和20年二尖瓣返流≥中度的累计发生率分别为4.5%±1.2%、11.1%±1.9%、16.4%±2.2%和20.2%±2.7%。所有患者10年和20年生存率分别为83.6%±2%和55.0%±4%。结论smimvs可安全进行，围手术期预后良好，死亡率低，长期瓣膜性能良好。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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