Minimally invasive mitral valve repair for commissural prolapse: Safety, success, and long-term efficacy.

Objectives: Commissural prolapse (CP) is a rare and complex mitral valve pathology which is complicated in preoperative diagnosis and repair. This study evaluated the safety, success, and long-term efficacy of minimally invasive mitral valve repair (MIMVR) for CP compared to posterior leaflet prolapse (PMLp).

Methods: Between 2001 and 2022, 34 patients with CP and 590 with PMLp underwent MIMVR at our center. Operative, perioperative, and long-term follow-up data were retrospectively collected. Surgical success was defined as freedom from conversion to valve replacement, sternotomy, and residual mitral regurgitation (MR) > grade I. Long-term efficacy included MR recurrence, reoperation, and survival.

Results: Median age was similar (CP: 64.0 years [53.2; 69.8] vs PMLp: 62.0 years [53.0; 69.0], p = 0.783). Barlow's disease was more frequent in PMLp (80.3% vs 32.4%, p < 0.001). Cross-clamp (127.0 min vs 105.0 min, p = 0.001) and bypass times (208.5 min vs 190.5 min, p = 0.031) were longer in CP. CP patients had longer hospital stays (10.0 days [8.0; 12.0] vs 8.0 days [7.0; 9.0], p < 0.001), but short-term outcomes, including 30-day mortality, stroke, and ECMO support, were comparable. At a median follow-up of 4.5 years (CP) and 2.4 years (PMLp, p = 0.001), rates of recurrent MR, reoperation, and survival were similar.

Conclusions: MIMVR for CP is safe, successful, and durable with outcomes comparable to PMLp. Despite greater technical complexity and longer operative times, this approach provides reliable results for CP.