Outcomes of complex mitral valve repair through right mini-thoracotomy using artificial chordae

Abstract

Mitral regurgitation (MR) affects 2%–3% of the global population. The rising incidence of degenerative causes in developing countries leads to an increase in the number of surgeries for degenerative MR. In this study, we aimed to evaluate the safety, feasibility, and effectiveness of minimally invasive mitral repair (MIMR) using artificial chordae in complex cases of mitral valve regurgitation. This is a retrospective analysis of MIMR through right mini-thoracotomy approach with intermediate-to-complex level of repair difficulty. We analyzed the demographic information, echocardiography results, surgical details, and mid-term survival outcomes. 49 patients underwent surgery with a mean age of 49.1±13.3 years. 34 patients (69.39%) were classified as having intermediate level of MR complexity, four patients (8.2%) had a complex mitral valve score, and 11 patients (22.4%) were diagnosed with Barlow’s disease. We performed a ring annuloplasty in all patients, with additional repair techniques including edge-to-edge (10.2%), commisuroplasty (26.5%), and interscallop indentation closure (22.5%). There were no in-hospital deaths. We recorded three cases with minor complications: one case of pleural effusion, one case of low cardiac output syndrome, and one case of acute lower limb compartment syndrome. Cumulative recurrent MR rates measured at 12-mon, 24-mon and 36-mon are 92%, 88%, and 84%, respectively. MIMR of complex mitral valves using artificial chordae was effective, with low complication and recurrent rates. Optimal results can be achieved through proper lesion evaluation and choosing the appropriate repair strategies using artificial chordae combining with edge-to-edge, commisuroplasty or indentation closure techniques.