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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
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Right Ventricular Function After Mitral Valve Surgery: Insights From the United Kingdom Mini Mitral Study
Christopher Bayliss1, Janelle Wagnild2, Rebecca Maier3
1Department of Cardiac Surgery, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom.
The Annals of Thoracic Surgery
|January 9, 2026
Summary
Minimally invasive mitral valve repair using right minithoracotomy better preserves right ventricular (RV) function compared to sternotomy, even with longer procedure times. This improved RV function was observed at 12 weeks and one year post-surgery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Function Assessment
- Minimally Invasive Procedures
Background:
- Right ventricular (RV) dysfunction is a common complication after cardiac surgery, linked to increased mortality.
- Mitral valve repair techniques, specifically sternotomy versus right minithoracotomy, may impact RV function.
- Understanding the long-term effects of surgical approach on RV function is crucial for patient outcomes.
Purpose of the Study:
- To compare the impact of mitral valve repair via right minithoracotomy versus sternotomy on right ventricular (RV) function.
- To assess changes in RV function using echocardiography at pre-operative, 12-week, and 52-week time points.
Main Methods:
- Randomized controlled trial (UK Mini Mitral Trial) comparing right minithoracotomy and sternotomy for mitral valve repair.
- Echocardiography used for blinded assessment of cardiac function, including tricuspid annular plane systolic excursion (TAPSE) for RV function.
- RV to pulmonary artery coupling evaluated by the TAPSE to systolic pulmonary artery pressure ratio.
Main Results:
- A significant reduction in TAPSE from baseline was observed in both groups at 12 weeks, with partial recovery by 52 weeks, but not to pre-operative levels.
- The degree of RV impairment, measured by TAPSE, was significantly less in the right minithoracotomy group at both 12 weeks (1.47mm difference) and 52 weeks (1.37mm difference).
- Despite longer cross-clamp and bypass times in the minithoracotomy group, RV function was better preserved.
Conclusions:
- Mitral valve repair performed via right minithoracotomy demonstrates superior preservation of right ventricular (RV) function compared to sternotomy.
- The benefits in RV function preservation were evident at both early (12 weeks) and late (52 weeks) post-operative assessments.
- Right minithoracotomy represents a potentially advantageous surgical approach for mitral valve repair concerning RV function outcomes.
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