MINIMALLY INVASIVE MITRAL VALVE SURGERY IN ELDERLY

Background: Right anterior minithoracotomy has become the preferred approach for mitral valve surgery. This study assesses outcomes in elderly patients to determine potential benefits. Materials and Methods: From January 2010 to May 2024, 4092 adult patients underwent mitral valve repair or replacement, with 1687 using a minimally invasive approach. We focused on elderly patients aged ≥75 years (n=383) treated with a minimally invasive approach and a subgroup aged ≥80 years (n=144). Results: In patients aged ≥75 years, 48.3% were male. Among 383 patients, 1.8%(n=7) had endocarditis, 6.3%(n=24) had undergone previous cardiac surgery. The median logistic EuroSCORE was 7.48(IQR 4.92). Median cardiopulmonary bypass time was 95 (IQR 56) minutes and aortic cross-clamp time was 76 (IQR 46) minutes. Median ventilation time was 7(IQR 7) hours, and median ICU stay was 2 days. Main postoperative complications were atrial fibrillation (20.1%) and acute renal failure (3.1%). The hospital mortality rate was 3.1% (n=11). In the ≥80 years subgroup, the Logistic EuroSCORE increased to 8.97, with a mortality rate of 5.3%. Atrial fibrillation (22%) and acute renal failure (3.5%) were the most common complications. Logistic regression identified acute renal failure as a key risk factor for mortality (p<0.001) in both the main groups Preoperative risk factor analysis using logistic regression identified the logistic EuroSCORE as the only significant risk factor (p=0.013), with mortality notably increasing when the logistic EuroSCORE was ≥11.59 Conclusions: Right anterior minithoracotomy is a safe and reproducible approach, even for elderly patients, promoting faster recovery with lower risks of complications.