• Mitral valve
• mitral valve degenerative disease
• mitral valve surgery

The purpose of this thesis is to report and analyze early and long-term outcomes in asymptomatic patients who underwent minimally invasive mitral valve surgery through right minithoracotomy at Ospedale del Cuore - Fondazione Toscana Gabriele Monasterio in the setting of degenerative disease. A total of 374 patients satisfying these characteristics had benefited from minimally invasive mitral valve surgery, and thus avoided median sternotomy, from 2004 to 2016.

Mitral regurgitation (MR), currently the most frequent valvular heart disease, is mostly degenerative, linked to aging, and of increasing prevalence. Mitral valve surgery is the only current approved treatment of MR. Cumulative evidence obtained worldwide show that early surgery in asymptomatic patients is the preferred approach. “Watchful waiting”, meaning closely observing the manifestation of symptoms such as dyspnea, heart palpitation and fatigue, or echocardiographic evidence of left ventricular dysfunction, is a failed strategy, because symptoms are insensitive markers of risk and often unrecognized in a timely manner and, even after successful surgery, associated with poor outcome. Furthermore, in patients with severe organic MR, surgery is almost unavoidable and early mitral repair before the appearance of symptoms or overt LV dysfunction and irreversible anatomical modifications may restore life expectancy.
At Ospedale del Cuore, OPA minimally invasive mitral valve surgery has become the standard approach since 2005, it is safe, reproducible, associated with low mortality and morbidity, high rate of mitral valve repair and excellent long-term results.

In this study, the mean age was 56 ± 13 years, 119 (31,8%) patients were female. Mean preoperative EF was 64 ± 4,9% and LVEDS 32,3 ± 4,6mm. MV repair was successfully performed in 358 patients, with a rate of success of 95,7%. Repair techniques included annuloplasty (93,6%), leaflet resection (65%), neochordae implantation (27,3%), and sliding plasty (17,1%).

Overall in-hospital mortality was 0%. Incidence of stroke was 1,1%, and at discharge MR was trivial or none. At mean follow-up of 53 ± 13 months, overall survival was 98,7%, freedom from reoperation 98,4% and 362 (96,8%) patients denied symptoms or a reduction in quality of life.

Our results are in line with recent literature: early surgery in asymptomatic patients may restore life expectancy to that of persons of similar age and sex who never had MR and never had cardiac surgery, as long as minimally invasive valve repair is performed in high-volume centers.