Early Results of Minimally Invasive Mitral Valve Repair through Upper Partial Sternotomy, 8 Years’ Single-Center Experience

Background: Upper partial sternotomy (UPS) as one of the less invasive cardiac surgical approaches has become the standard procedure in the valve surgery in our institution. In the study period, we have performed 1,781 cardiac operations through this approach. We report about the results of mitral valve repair via UPS.

Method: A total of 315 adult patients who underwent mitral valve repair as the single procedure (n = 208) or in combination with tricuspid valve repair (n = 107) between years 2012 and 2020 were included in the study. Emergency procedures were excluded according to EuroSCORE II definition (n = 2). Data were retrospectively collected and retrieved from our database. For standard UPS approach, a skin incision of 8 to 10 cm was performed and the sternum was divided partially up to fourth left intercostal space. The distal ascending aorta and the superior and inferior vena cava were cannulated directly. All echocardiographic examinations were performed preoperatively and prior to discharge from the hospital by our Department of Cardiology.

Results: The mean age in the study was 63.7 ± 13.5 years and 37% of patients were males. The mean EuroSCORE II was 5.0 ± 2.6 and 30-day mortality 1.3% (4 patients); the median postoperative ICU stay 2 days (1–49 minute-max) and the mean X-clamp time 100.3 ± 22.4 minutes. Sliding mitral leaflet plastic was performed in 77.5%, artificial chordae replacement in 67% of cases. Eleven patients (3.5%) developed respiratory failure; two (0.6%) postoperative strokes occurred; 12 patients (3.8%) required revision for bleeding and 13 (4.1%) pacemaker implantations were necessary after surgery. Echo-control (99.56% follow-up) before discharge from the hospital showed mitral regurgitation grade 0 in 76.5% of cases, grade I in 22.1%, grade II in 1.3% and no severe regurgitation. Two patients (0.6%) suffered deep sternal wound infection.

Conclusion: Mitral valve surgery with concomitant tricuspid valve repair performed through UPS provides excellent postoperative results. UPS is feasible and can be performed with low risk for patients. UPS provides good cosmetic result and preserved stability of the thorax may be beneficial in terms of faster postoperative recovery.

Publication History

Article published online:
03 February 2022