Minimally invasive papillary muscle sling placement during mitral valve repair in patients with functional mitral regurgitation

Orlando Santana, Natalia V Solenkova, Andres M Pineda, Christos G Mihos, Joseph Lamelas
Journal of Thoracic and Cardiovascular Surgery 2014, 147 (1): 496-9

BACKGROUND: We evaluated the safety and feasibility of minimally invasive mitral valve repair with papillary muscle sling placement via a right anterior thoracotomy approach in patients with severe functional mitral regurgitation (MR).

METHODS: We retrospectively reviewed all minimally invasive mitral valve repairs with papillary muscle sling placement in patients with severe functional MR performed at our institution between October 2011 and September 2012. The operative times, lengths of stay, postoperative complications, and mortality were analyzed.

RESULTS: We identified a total of 19 consecutive patients. There were 12 men (63%); the mean age was 60 ± 13 years. The mean ± SD left ventricular ejection fraction was 23% ± 5.5%, and 4 (21%) of the patients underwent previous coronary artery bypass graft surgery. The median aortic cross-clamp and cardiopulmonary bypass times were 106 (interquartile range [IQR], 76-120) and 163 (IQR, 119-170) minutes, respectively. The median intensive care unit length of stay was 64 (IQR, 43-75) hours, and the median postoperative length of stay was 7 (IQR, 5-7.5) days. Postoperatively, 2 patients developed acute kidney injury. There were no reoperations for bleeding or any cerebrovascular accidents. The 30-day mortality was 0. A follow-up echocardiogram, obtained at a median of 3 (IQR, 1-7.5) months, demonstrated none to trivial MR in all patients.

CONCLUSIONS: Minimally invasive mitral repair with papillary muscle sling placement for severe functional MR is safe and effective in the short-term. Long-term data are needed to evaluate the effects on left ventricular remodeling and to assess the durability of the repair.

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