Long-term echocardiographic evaluation of asymptomatic patients undergoing minimally invasive valve repair for severe primary mitral regurgitation.

BACKGROUND: Asymptomatic patients with a new diagnosis of primary, severe mitral regurgitation may not be candidates for surgery when clinical guidelines are taken into consideration. AIMS: To determine whether asymptomatic patients with severe, primary mitral regurgitation benefit from minimally invasive mitral valve repair Methods: Consecutive, asymptomatic patients who underwent mitral valve repair through right mini-thoracotomy were prospectively analyzed. Ventricular ejection fraction, end-diastolic volume, end-systolic volume, end-diastolic diameter, end-systolic diameter; left atrial area and volume) were measured along with clinical evaluation (MACCE- death, reoperation, hospitalization due to heart failure, new onset atrial fibrillation, stroke) in 6th, 12th and 24th month following the surgery. RESULTS: 114 patients were included in the report. 16 (14%) patients were lost to echocardiographic follow-up. Follow-up regarding mortality was 100%- no patient died in 24 months following the surgery. Comparison of median baseline and 24-month EF (68.0% vs 60.0%; P < 0.001), EDV (165.0cm3 vs 107.5cm3; P < 0.001), ESV (51.0cm3 vs 43.5cm3; P = 0.02), EDD (58mm vs 49mm; P < 0.001), ESD (35mm vs 30mm; P < 0.001), LA area (26cm2 vs 18cm2; P < 0.001), LA volume (96.0cm3 vs 49.5cm3; P < 0.001) revealed significant reverse remodeling in all analyzed parameters. Overall MACCE was 9 (9.2%), including 2 (2%) reoperations, 1 (1%) hospitalization due to heart failure, 6 (6.1%) new-onset atrial fibrillation episodes and 0 strokes. CONCLUSIONS: Minimally invasive mitral valve repair is a safe and efficient method of correction in asymptomatic patients. The intervention should be performed regardless of ventricular and atrial dimensions.