Mitral valve repair by right minithoracotomy compared with sternotomy: 21-year single-center experience

Right minithoracotomy mitral valve surgery has become a minimally invasive alternative to median sternotomy, although long-term outcomes remain incompletely defined. This study compared early and late outcomes of the 2 approaches in patients with degenerative mitral regurgitation.

A single-center retrospective analysis was performed of 976 patients (mean age 60 ± 13 years) who underwent mitral valve repair, with or without concomitant procedures, between 2001 and 2022. Patients were categorized by surgical approach: sternotomy (n = 437) or right minithoracotomy (n = 539). Early outcomes, long-term mortality, cumulative incidence of mitral-related reintervention, and serial echocardiographic changes were evaluated.

Median (interquartile range) clinical follow-up was 12.8 (8.4-16.6) years in the sternotomy group and 4.9 (3.1-7.1) years in the minithoracotomy group. In the matched cohort, the minithoracotomy approach was associated with shorter operative time and reduced hospital stay. In-hospital mortality was 0% in both approaches. The long-term all-cause mortality and cumulative incidence of mitral-related reoperation were comparable between the approaches. The mixed-effect model indicated both approaches achieved durable mitral regurgitation reduction and favorable left ventricular remodeling, whereas minithoracotomy showed greater reductions in left atrial size and tricuspid regurgitation pressure gradient.

Compared with sternotomy, right minithoracotomy mitral repair provided excellent early safety and faster recovery. Long-term repair durability, reflected by comparable cumulative incidence of mitral-related reoperation, was similar to sternotomy, whereas survival estimates should be interpreted in the context of differential follow-up duration. When performed at experienced centers, minimally invasive mitral valve repair represents a viable alternative for degenerative mitral regurgitation.