Evolution of Minimally Invasive Mitral Valve Repair: 30-Year Experience From a High-Volume Center

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Valvular Heart Disease

Background:

• Minimally invasive mitral valve repair (MVr) is a standard procedure, often combined with tricuspid valve (TV) surgery.
• Limited evidence exists on the long-term outcomes and their evolution over time for these combined procedures.
• This study investigates improvements in outcomes for minimally invasive MVr, both isolated and with concomitant TV surgery, over several decades.

Purpose of the Study:

• To evaluate the long-term survival trends following minimally invasive mitral valve repair (MVr).
• To assess the evolution of outcomes for minimally invasive MVr performed with or without concomitant tricuspid valve (TV) surgery.
• To determine if surgical outcomes have improved over different time periods.

Main Methods:

• Retrospective analysis of 5559 patients undergoing minimally invasive MVr between 1996 and 2023.
• Patients were categorized into five surgical periods from 1996-2001 to 2020-2023.
• Primary outcome was 10-year survival; subanalysis included patients with concomitant TV surgery.

Main Results:

• 30-day mortality decreased from 1.1% in 1996-2001 to 0.3% in 2020-2023.
• 10-year survival improved from 68.1% (1996-2001) to 83.7% (2014-2019).
• For concomitant TV surgery, 1-year and 10-year survival rates significantly improved across periods.

Conclusions:

• Minimally invasive MVr, alone or with TV surgery, is a safe and reproducible approach.
• The procedure is associated with low complication rates and infrequent conversion to sternotomy.
• Excellent early and long-term survival rates have been achieved and improved over time.