Comparison of Left Ventricular Functional Recovery and Remodeling After Total Thoracoscopic Mitral Valve Repair and Replacement in Patients With Mitral Regurgitation and Mildly to Moderately Reduced Left Ventricular Ejection Fraction

Background: Total thoracoscopic mitral valve surgery (TT-MVS) is a minimally invasive technique for mitral regurgitation (MR), but its impact on left ventricular (LV) function and remodeling in patients with reduced LV ejection fraction (LVEF) is unclear. Methods: We retrospectively compared 94 patients who underwent total thoracoscopic mitral valve repair (TT-MVr) or total thoracoscopic mitral valve replacement (TT-MVR) for MR and reduced LVEF at our center from January 1, 2017, to December 31, 2022. We assessed LV functional recovery and remodeling by echocardiography at baseline, 1 week, 3 months, and 6 months after surgery. Results: A total of 43 patients underwent TT-MVr and 51 patients underwent TT-MVR. Both groups had similar early outcomes, hospital mortality, and postoperative complications. The TT-MVr group had higher LVEF and lower left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) than the TT-MVR group at 3 and 6 months after surgery (p < 0.05 for all comparisons). Both groups improved in New York Heart Association (NYHA) functional class from baseline to 6 months after surgery (p < 0.05 for all comparisons). Conclusion: TT-MVr and TT-MVR are feasible and safe for patients with MR and reduced LVEF, but TT-MVr is associated with better LV functional recovery and remodeling within 6 months after surgery. TT-MVr should be preferred over TT-MVR whenever possible in this high-risk population. Further studies are needed to evaluate the long-term outcomes of TT-MVS in this population.