Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse.

OBJECTIVE We sought to compare the outcomes of minimally invasive mitral valve (MV) surgery for anterior (anterior mitral leaflet, AML), posterior (posterior mitral leaflet, PML) or bileaflet (BL) MV prolapse. METHODS Between August 1999 and December 2007, 1230 patients who presented with isolated AML (n=156, 12.7%), isolated PML (n=672, 54.6%) or BL (n=402, 32.7%) MV prolapse underwent minimally invasive MV surgery. The preoperative mitral regurgitation (MR) grade was 3.3+/-0.8, left ventricular ejection fraction (LVEF) was 62+/-12% and mean age was 58.9+/-13.0 years; 836 patients (68.0%) were male. Mean follow-up time was 2.7+/-2.1 years, and the follow-up was 100% complete. RESULTS Overall, the MV repair rate was 94.0% (1156 patients). Seventy-four patients (6.0%) received MV replacement. MV repair for PML prolapse was accomplished in 651 patients (96.9%), for AML in 142 patients (91%) and for BL in 363 patients (90.3%). Repair techniques consisted predominantly of leaflet resection and/or implantation of neochordae, combined with ring annuloplasty. Concomitant procedures were tricuspid valve surgery (n=56), atrial fibrillation ablation (n=286) and closure of an atrial septal defect or patent foramen ovale (PFO) (n=89). The overall duration of cardiopulmonary bypass was 127+/-40 min and aortic cross-clamp time was 78+/-33 min. The mean postoperative hospital stay was 11.6+/-9.7 days for the overall group. Early echocardiographic follow-up revealed excellent valve function in the vast majority of patients, regardless of the repair technique, with a mean MR grade of 0.3+/-0.5. For the overall group, 5-year survival rate was 87.3% (95% CI: 83.9-90.1) and 5-year freedom from cardiac reoperation rate was 95.6% (95% CI: 94.1-96.7). The log-rank test revealed no significant difference between the three groups regarding long-term survival or freedom from reoperation. CONCLUSIONS Minimally invasive MV repair can be achieved with excellent results. Long-term outcomes and reoperation rates for AML prolapse are not significantly different from PML or BL prolapse.