ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2020 October;61(5):639-47

DOI: 10.23736/S0021-9509.20.11127-3

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Echocardiographic and clinical outcome after mitral valve plasty with a minimal access or conventional sternotomy approach

Lotte E. de GROOT-de LAAT ^{1, 2} ✉, Kevin M. VEEN ^{1, 2}, Jackie MCGHIE ^{1, 2}, Frans B. OEI ^{1, 2}, Wouter J. van LEEUWEN ^{1, 2}, Ad J. BOGERS ^{1, 2}, Marcel L. GELEIJNSE ^{1, 2}

¹ Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands; ² Department of Cardiothoracic Surgery, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands

BACKGROUND: The aim of this study is to evaluate the effects of minimal access mitral valve surgery (MAMVS) versus conventional surgery with or without concomitant tricuspid valve plasty (TVP) in consecutive patients with mitral regurgitation (MR) on clinical and echocardiographic outcome.
METHODS: One-hundred-and-twenty patients operated for MR (91 conventional and 29 MAMVS) were followed by echocardiography and quality of life assessment before and 6 months after surgery.
RESULTS: Patients in the MAMVS group were younger, more often in NYHA functional class I-II and had lower NT-proBNP levels. Only four patients (all in the conventional group) underwent mitral valve replacement. There were no significant differences in complications between MAMVS and conventional surgery. At 6 months, comparable MR reduction and left ventricular remodeling data were seen, left atrial remodeling was most prominent in the MAMVS group, 71 [55-90] to 43 [35-58] versus 69 [53-89] to 49 [41-70] mL/m² in the conventional group (P<0.05). Significant improvement for all quality of life domains were seen, except for pain, with no intergroup differences. Twenty-seven (23%) patients underwent concomitant TVP, all in the conventional group. Tricuspid regurgitation decreased after concomitant TVP (P<0.001), whereas in patients with no TVP no significant changes occurred. At 6 months tricuspid regurgitation grade was comparable in patients with TVP versus patients without need for TVP.
CONCLUSIONS: MR severity reduced significantly, with no difference between conventional surgery and MAMVS in reducing MR, with superior left atrial remodeling in the MAMVS group. In-hospital complications and NYHA class and quality of life assessment were not different between conventional surgery and MAMVS.

KEY WORDS: Mitral valve insufficiency; Echocardiography; Tricuspid valve insufficiency; Mitral valve annuloplasty; Minimally invasive surgical procedures