Minimally invasive mitral valve repair or replacement for degenerative mitral regurgitation

OBJECTIVES This study describes our experience with minimally invasive mitral valve (MV) repair and chordal-sparing replacement in patients with degenerative MV regurgitation. METHODS Between February 2009 and October 2015, a total of 960 patients underwent isolated minimally invasive MV repair, whereas 95 patients underwent chordal-sparing MV replacement. We performed a propensity score-matched analysis in 85 pairs to compare overall survival and major adverse cardiac and cerebrovascular event (MACCE)-free survival over an 8-year follow-up period. For sensitivity analyses, in the entire study cohort, we used the multivariable-adjusted Cox regression analysis to assess the overall mortality and MACCE. RESULTS In the propensity score-matched pairs, the 7-year probability of survival was 76.3% in the repair group and 78.8% in the replacement group (P=0.60). Similarly, freedom from MACCE at year 7 of follow-up did not differ between the repair and replacement groups (78.6% and 72.3%, respectively; P=0.48). The corresponding values for 7-year freedom from valve reintervention were 95.6% and 98.8%, respectively (P=0.31). In the entire study cohort, the multivariable-adjusted hazard ratio (HR) of mortality for the replacement versus the repair group was 1.31 [95% confidence interval (CI) 0.68-2.50; P=0.42], and the multivariable-adjusted HR of MACCE was 1.03 (95% CI 0.61-1.74; P=0.91). CONCLUSIONS Our findings suggest that mid-term clinical outcomes do not significantly differ between patients undergoing MV repair or chordal-sparing MV replacement.