PMID- 37426140
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230718
IS  - 2072-1439 (Print)
IS  - 2077-6624 (Electronic)
IS  - 2072-1439 (Linking)
VI  - 15
IP  - 6
DP  - 2023 Jun 30
TI  - Midterm outcomes of minimally invasive mitral valve surgery in a heterogeneous 
      valve pathology cohort: respect or resect?
PG  - 3013-3024
LID - 10.21037/jtd-22-1796 [doi]
AB  - BACKGROUND: Minimally invasive mitral valve surgery (MIV) through a right lateral 
      thoracotomy has become the standard of care at specialized centers and might soon 
      will be the only acceptable surgical treatment option in the future era of 
      interventional procedures. The aim of our study was to analyze the outcomes of 
      our MIV-specialized, single-center, mixed valve pathology cohort with regard to 
      morbidity, mortality and midterm outcomes comparing two different repair 
      techniques (respect versus resect). METHODS: Baseline and operative variables, 
      postoperative outcomes and follow-up information about survival, valve competence 
      and freedom from reoperation were retrospectively collected and analyzed. The 
      repair cohort was divided into three groups (resection, neo-chordae and both) and 
      compared for outcomes. RESULTS: Between July 22(nd) 2013 and May 31(st) 2022 a 
      total of 278 consecutive patients underwent MIV. Out of those, we identified 165 
      eligible patients for the three repair groups: 82 patients (29.5%) had 
      "resection", 66 "neo-chordae" (23.7%) and 17 "both" (6.1%). All preoperative 
      variables were comparable between the groups. The predominant valve pathology of 
      the entire cohort was degenerative disease with 20.5% Barlow's, 20.5% bi-leaflet 
      and 32.4% double segment pathology. Bypass time was 164+/-47, cross-clamp time 
      106+/-36 minutes. All valves planned for repair (85.6%) were successfully repaired 
      except for 13 resulting in a repair rate of 94.5%. Only 1 patient (0.4%) had to 
      be converted to clamshell and 2 (0.7%) needed rethoracotomy for bleeding. Mean 
      intensive care unit (ICU) stay was 1.8 days and hospital stay 10.6+/-1.3 days. 
      In-hospital mortality was 1.1% and the incidence of stroke (1.8%). All 
      in-hospital outcomes were comparable between the groups. Follow up was complete 
      in 86.2% (n=237) for a mean of 3.7+/-0.8, up to 9 years. Five-year survival was 
      92.6% (P=0.5) and freedom from re-intervention 96.5% (P=0.1). All but 10 patients 
      had mitral regurgitation less than grade 2 (95.8%, P=0.2) and all but two had 
      less than New York Heart Association (NYHA) II (99.2%, P=0.1). CONCLUSIONS: 
      Despite a heterogeneous cohort with mixed valve pathologies, there is a high 
      reconstruction rate, low short- and midterm morbidity, mortality and need for 
      re-intervention with comparable outcomes of the resect and respect technique in a 
      specialized MIV center.
CI  - 2023 Journal of Thoracic Disease. All rights reserved.
FAU - Passos, Laina
AU  - Passos L
AD  - Heart Clinic Hirslanden, Zuerich, Switzerland.
FAU - Aymard, Thierry
AU  - Aymard T
AD  - Heart Clinic Hirslanden, Zuerich, Switzerland.
FAU - Biaggi, Patric
AU  - Biaggi P
AD  - Heart Clinic Hirslanden, Zuerich, Switzerland.
FAU - Morjan, Mohammed
AU  - Morjan M
AD  - Clinic for Cardiovascular Surgery, Heart Center Duisburg, Duisburg, Germany.
FAU - Emmert, Maximilian Y
AU  - Emmert MY
AD  - Deutsches Herzzentrum der Charite (DHZC), Department of Cardiothoracic and 
      Vascular Surgery, Berlin, Germany.
AD  - Charite-Universitatsmedizin Berlin, Berlin, Germany.
FAU - Gruenenfelder, Juerg
AU  - Gruenenfelder J
AD  - Heart Clinic Hirslanden, Zuerich, Switzerland.
FAU - Reser, Diana
AU  - Reser D
AD  - Heart Clinic Hirslanden, Zuerich, Switzerland.
LA  - eng
PT  - Journal Article
DEP - 20230620
PL  - China
TA  - J Thorac Dis
JT  - Journal of thoracic disease
JID - 101533916
PMC - PMC10323544
OTO - NOTNLM
OT  - Minimally invasive mitral surgery
OT  - leaflet resection
OT  - neo-chordae
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at 
      https://jtd.amegroups.com/article/view/10.21037/jtd-22-1796/coif). The authors 
      have no conflicts of interest to declare.
EDAT- 2023/07/10 06:42
MHDA- 2023/07/10 06:43
PMCR- 2023/06/30
CRDT- 2023/07/10 05:06
PHST- 2022/12/12 00:00 [received]
PHST- 2023/03/03 00:00 [accepted]
PHST- 2023/07/10 06:43 [medline]
PHST- 2023/07/10 06:42 [pubmed]
PHST- 2023/07/10 05:06 [entrez]
PHST- 2023/06/30 00:00 [pmc-release]
AID - jtd-15-06-3013 [pii]
AID - 10.21037/jtd-22-1796 [doi]
PST - ppublish
SO  - J Thorac Dis. 2023 Jun 30;15(6):3013-3024. doi: 10.21037/jtd-22-1796. Epub 2023 
      Jun 20.