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| |  Minimally Invasive Techniques Achieve Excellent Outcomes in Patients With Mitral Valve Regurgitation: Presented at STS By Charlene Laino FORT LAUDERDALE, Fla -- January 27, 2010 -- In patients with severe mitral valve regurgitation, minimally invasive surgical approaches achieve similarly excellent outcomes to sternotomy, researchers reported here at the Society of Thoracic Surgeons (STS) 46th Annual Meeting. The study also suggested that mitral valve regurgitation surgery should be performed prior to patients developing New York Heart Association (NYHA) class III or IV symptoms. Louis-Mathieu Stevens, MD, Research Center and Department of Surgery, Hospital of University of Montreal, Montreal, Quebec, presented the results here on January 26. The researchers retrospectively reviewed data on 1,289 patients with mitral valve regurgitation who underwent isolated mitral valve surgery at their institution between 1992 and 2008. Of the total, 1,040 patients underwent mitral valve repair and 249 underwent mitral valve replacement surgery. The surgical approaches included sternotomy in 378 patients, right mini-thoracotomy video surgery in 474 patients, and robotically assisted surgery in 437 patients. The mean follow-up time was 4.5 years. The prevalence of sternotomy mitral valve repair decreased from 66% in 1992-1998 to 20% in 1999-2002 and 8% in 2004-2008. At the same time, robotic mitral valve repair increased from 0% to 34% and 57% in the same time periods. Patients who underwent robotic group surgery tended to be younger and male and have better ejection fractions and myxomatous degeneration (P < .001 for all). The 30-day mortality rate was 2% regardless of which of the 3 approaches was used (P = .409). Robotic surgery was associated with a significantly higher 5-year survival rate: 95%, compared with 87% for patients who underwent sternotomy and 82% for patients who had videoscopic surgery (P < .001). In a multivariate model adjusted for age, NYHA class, renal failure, ejection fraction, and mitral valve etiology, the 5-year survival rate was similar for all approaches (P = .055). Patients with NYHA class I-II symptoms and myxomatous degeneration or annular dilatation had similar survival rates to an age- and gender-matched population. However, the 5-year survival rate was significantly worse for patients with NYHA class III-IV symptoms: 83% versus 93% for those with NYHA class I-II symptoms (P < .01). [Presentation title: Impact of Timing and Surgical Approach on Outcomes Following Mitral Valve Regurgitation Surgery. Abstract 1]
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