Minimally invasive mitral valve surgery in octogenarians: Mid-term results

Objective: Minimally invasive mitral valve surgery is of increasing interest. Here we report our experience with this procedure in octogenarians.

Methods: 43 patients underwent elective mitral surgery via a right lateral mini-thoracotomy. Mean age was 82.1±1.8 years. Four patients were diagnosed with combined mitral stenosis and insufficiency, and 39 patients with isolated regurgitation. Prolapse of the AML (PML) was present in 7 (14), and bileaflet prolapse in 4 patients. Preoperative left-ventricular function was 55±21%. The majority of the patients were in NYHA class III. One patient had previously undergone mitral surgery. CPB was conducted via the femoral vessels and the aorta was Chitwood-clamped.

Results: Mean duration of CPB was 101±43min, and aortic-clamp time was 56±29min. Mitral reconstruction using a valvuloplasty ring only was performed in 8 patients. Twelve patients underwent complex reconstruction including ring, resection, or chordae-replacement. Concomitant procedures included tricuspid valve reconstruction (n=4), ASD closure (n=3), and cryoablation (n=8). Ten patients underwent mitral valve replacement. Intraoperative course was uneventful. Chest blood drainage was 424±485ml. Mean duration of hospital stay was 17±11 days. Two patients presented non-residual minor neurological deficits. Early postoperative echocardiography follow-up after reconstruction showed no patients with moderate or more MI. Follow-up was obtained in all patients. Average duration of follow-up was 19.3±17.6 months. There were no reoperations during follow-up. Thirty-day survival was 97.7%, and one year survival was 81.4%.

Conclusion: Minimally invasive mitral valve surgery achieves favorable results in octogenarians and offers a good alternative to the conventional approach.