Isolated minimally invasive mitral valve surgery in octogenarians: perioperative outcome

Introduction: Despite the feasibility, safety, and excellent outcomes of mitral valve surgery through a right mini-thoracotomy, there is a data paucity about its use in octogenarians. In this study, we assess the outcomes of mitral valve surgery via right mini-thoracotomy in octogenarians. Methods: We performed a retrospective analysis of the in-hospital perioperative data of 38 octogenarian patients with severe mitral regurgitation undergoing isolated mitral valve surgery via right mini-thoracotomy from 2013 to 2021 in our institution. Results: The median patient age was 82(81-83) years, and the median EuroSCORE II was 3.1%(2.3-4.9). A total of 19(50%) patients underwent mitral valve repair. The median cardiopulmonary bypass duration was 78(54-100) minutes and the median aortic cross-clamping duration was 57(40-70) minutes. Two (5.3%) patients were converted to sternotomy, 1(2.6%) underwent renal replacement therapy, 5(13.2%) underwent reexploration for bleeding or tamponade, and 12(31.6%) underwent permanent pacemaker implantation. The surgical repair success rate was 89.5%, with 2(10.5%) patients requiring reoperation due to repair failure. No other patients required reoperation on the mitral valve. The median intensive care unit stay was 1(1-2) day, and the median postoperative stay was 9.5(8-14) days. There was no perioperative stroke or death. Conclusion: Despite a relatively increased risk of pacemaker implantation and reexploration for bleeding, our data support the feasibility of mitral valve surgery via a right mini-thoracotomy in octogenarians, with short ischemic times, low overall in-hospital morbidity, and no mortality. Preferring replacement in mitral diseases with a high risk for repair failure could minimize reoperations in this high-risk subgroup.