Introduction
While mitral valve repair is widely accepted to be superior to
replacement in appropriate cases, the optimal surgical approach to the
mitral valve (MV) continues to evolve[1]. The traditional approach
to the MV is via a full sternotomy. This approach provides excellent
exposure to the heart, great vessels, and MV, allows for central
arterial and venous cannulation, and allows the ability to perform
concomitant cardiac procedures as well as optimally and expeditiously
deal with complications[1].
The “minimally invasive techniques” include a variety of approaches to
the MV via smaller incisions. The most common minimally invasive
approaches to the MV are a small right anterior thoracotomy and a lower
hemisternotomy. Reported advantages of less invasive approaches include
less blood loss with fewer transfusions, decreased ventilation times,
reduced intensive care and overall hospital lengths of stay, and a
reduced time to return to normal activity[2]. Despite these
advantages, the less invasive approaches are technically more
challenging, require specialized training and equipment, and in some
cases, are associated with higher rates of stroke, aortic dissection,
and groin complications associated with peripheral cannulation [3].
While many studies have shown equivalent perioperative outcomes of less
invasive MVr to standard sternotomies, the number of studies examining
long term mortality and valve durability are somewhat limited[4-12].
In the present study, we sought to perform a comparative longitudinal
analysis of risk factors for death, reoperation, and progression of
mitral regurgitation after MVr performed via a full sternotomy and our
preferred minimally invasive approach to the MV, a small right anterior
thoracotomy.