• minitoracotomia cardiochirurgia cuore mitrale

The purpose of this thesis is to report and analyse early and long-term outcomes of all patients that underwent minimally invasive mitral valve surgery through right minithoracotomy at Fondazione Toscana Gabriele Monasterio - Ospedale del Cuore. In September 2003 the first patient was operated on using this technique. At the end of December 2013, a total of 1604 consecutive patients had benefited from minimally invasive mitral valve surgery and thus avoided median sternotomy.
The mean age was 63±13 years, 770 (48%) patients were female and 218 (13.6%) had previous cardiac operations. The prevailing etiology was degenerative valve disease (n=1114, 70%), followed by functional mitral regurgitation (n=191, 12%), rheumatic disease (n=151, 9.4%), endocarditis (n=80, 5%) and prosthetic dysfunction (3.2%). Repair rate was 71% overall (n=1137) and even higher (82%, n=932) in the degenerative disease subgroup. Techniques included annuloplasty (95%), leafleat resection (63%), neochordae implantation (16%), and sliding plasty (11%). 476 (29%) patients had their valve replaced. Concomitant procedures included tricuspid valve repair (n=234, 14.6%), atrial fibrillation ablation (n=152, 9.5%) and atrial septal defect closure (n=51, 3.2%). Direct aortic cannulation was achieved in 1289 (80.4%) patients.
Overall in-hospital mortality was 1.1% (n=19), lower than predicted by EuroSCORE I (median 6%, interquartile range 3-14%). 34 patients (2.1%) required conversion to standard sternotomy, while 32 (2%) had a stroke. Overall survival at 10 years was 88±2% and freedom from reoperation at 10 years was 91±1% for repair and 82±6% for replacement. Freedom from recurrent mitral regurgitation ≥3+ after 5 years was 94±2%.
In summary, minimally invasive mitral valve surgery is safe, reproducible, and associated with low mortality and morbidity, high rate of mitral valve repair and excellent long-term results.