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Durability of Mitral Valve Repair after Organic Mitral Insufficiency: 1-year-Follow-up Results in a Single Institutional Experience with Video-assisted Minimally Invasive Approach
Udo Boeken, Jan-Philipp Minol, Tobias Weinreich, Hiroyuki Kamiya, P Akhyari, Artur Lichtenberg.
University Hospital, Duesseldorf, Germany.

Objective: The feasibility of successful repair of Carpentier type II mitral insufficiency via MICS could be shown in different studies. However, due to the variety of underlying diseases, there is a great interest with regard to the durability of reconstructive surgery. Here we present our results with special regard to one-year-folllow-up. Methods: For the prolaps of the anterior leaflet, implantation of neo-chordae (4/0 Gere-Tex) was the technique of choice. Resection of the leaflet was applied only for P2-prolaps with excessive tissue, and a sliding plastic was only done if inevitable due to calcification of the anulus or high risk for systolic anterior motion. Prolaps of the small P2-segment was treated with neo-chordae implantation. Prolaps of P1 and P3 was always treated with neo-chordae independent on the size of the segment. For the prolaps of both leaflets with excessive tissues (Barlow-syndrome), P2-resection and chordal transfer from P2 to A2 were performed. Anuloplasty ring was used in all cases. Results: We identified 156 patients with organic mitral valve regurgitation (Carpentier Typ II) from 307 patients underwent video-assisted minimal-invasive mitral valve surgery via right mini-thoracotomy. Using our standardized strategy, repair rate was 94% in all patients, 88% for the anterior prolaps, 95% for the posterior prolaps, 78% for the prolaps of both leaflet and 100% for Barlow-syndrome. A closed ring was used in 51 patients of 146 repairs (34.9%). An open ring was inserted in 65.1%. Conversion to full sternotomy was necessary in 3 patients (2.0%) and early mortality was 1.3%. At follow-up, survival was 94.2 % in total. Freedom from reoperation was 87.2%. Mean left ventricular ejection fraction decreased from 62.3 ± 7.2 % at hospital discharge to 61.6 ± 7.0 % (p > 0.05) at follow in all patients. All follow-up results were comparable between the different underlying pathologies before mitral valve repair. Conclusions: The results clearly demonstrate that a very good short-term outcome with excellent repair rates after mitral valve repair could be realized. Our follow-up data one year after surgery confirm these results with regard to patients´survival and functionality of mitral valve.

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