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.