Fifteen Years of Minimally Invasive Mitral Valve Surgery: Single Centre Results in 1006 Patients

Objectives: The aim of the current study was to evaluate our institutional experience in mitral valve surgery with two different minimal invasive surgical approaches.

Methods: From January 1998 through December 2014 1006 patients underwent mitral valve surgery either through a partial upper sternotomy (PUS, n = 719) or through a right minithoracotomy (Chitwood, n = 287). Mean patient age was 61.5 ± 14 years for the PUS (95% with mitral valve insufficiency and 5% with mitral valve stenosis) and 55.5 ± 14 years for the Chitwood-group (97% with mitral valve insufficiency and 3% with mitral valve stenosis). Late follow up was 7.8 ± 7.2 years for the PUS (98% complete) and 10.5 ± 4.2 years for the Chitwood-group (94% complete).

Results: Mitral valve repair rate was comparable between the two techniques (PUS: 95% versus Chitwood: 97.5%; p = 0.34). In the PUS group 47% of the patients required concomitant procedures (Concomitant procedures Chitwood group: 5.5%; p = 0.01). There was no significant difference between PUS and Chitwood patients in postoperative bleeding (342 ± 134ml/12h versus 389 ± 73ml/12h) and 30-day survival (96% versus 98.3%). Overall incidence of early stroke was low with 2% for the PUS and 0.3% for the Chitwood group (p = 0.86). Late follow up data revealed similar results between the two groups regarding survival (PUS: 83,5 ± 4% versus Chitwood:79.4 ± 2%; p = 0.87) and freedom from mitral valve reintervention (PUS: 97 ± 2% versus Chitwood: 94.4 ± 2%; p = 0.79).

Conclusion: PUS is the standard approach for mitral valve surgery in our department facilitating combined procedures, training and avoids inguinal cannulation. The Chitwood approach is cosmetically more appealing in young female patients. Objective medical differences between the two approaches have not been substantiated yet.