A Simplified Technique for Complex Mitral Valve Regurgitation by a Minimally Invasive Approach

Complex mitral valve disease can require surgical repair techniques that are challenging in a minimally invasive context and may expose patients to prolonged cardiopulmonary bypass and cross-clamp times. This study reviewed a simplified stepwise operative approach for the treatment of complex bileaflet mitral disease, early outcomes, and midterm follow-up. A total of 140 consecutive patients with bileaflet disease underwent video-assisted minimally invasive right mitral valve repair at a surgical center (Anthea Hospital, Bari, Italy) between 2008 and 2016. Patients were treated with a technique consisting of relocating the head of P2 to the base of P1 with resection and sliding. If P1 was prolapsed, a commissural plication was performed. Neochordae were applied at the level of the anterior segments in cases of true prolapse or flail. An isolated complete ring was used in cases of bileaflet billowing. This study retrospectively reviewed early and midterm outcomes including follow-up echocardiographic data. There was no 30-day mortality, and successful mitral valve repair with no or trace mitral regurgitation was achieved in all but 1 patient. One patient at the beginning of the series required conversion to sternotomy, and 2 patients required immediate reoperation for systolic anterior movement. No deaths were reported at a median follow-up of 32 months, and the rate of freedom from mitral regurgitation (≥2+) was 94.7%. The type of repair did not influence the outcome. Complex mitral disease in its different forms can be successfully addressed with excellent early and midterm results by using a simplified stepwise minimally invasive mitral valve repair technique.