Flattening the Learning Curve of Minimally Invasive
Mitral Valve Repair.
Since minimally invasive mitral valve repair (Mini-MVr) technique was introduced, it has become a routine approach to mitral
valve disease. However, surgeons from low-volume centers might be reluctant to adopt this technique due to the initial learning
Between 2004 and 2017, 200 patients underwent a mitral valve repair (MVr) for degenerative mitral valve disease at our
institution. Fifty-eight (29%) patients underwent a Mini-MVr and 142 (71%) a conventional MVr. Previous to surgery, all patients
were assessed by the institutional Mini-MVr team, which is lead by an experienced cardiac surgeon. Mini-MVr were performed
by a right lateral minithoracotomy or periareolar approach while conventional repairs were performed through a conventional
median sternotomy. Variables were described according to the Society of Thoracic Surgeons database guidelines. Baseline
demographics and clinical characteristics were summarized using descriptive statistics.
Follow-up was 94% complete, mean follow-up time was 2.3 years. There was no 30-day mortality. Five patients required mitral
valve replacement after an average of 5.3 years. Patients from the Mini-MVr group were younger ( p=< 0,001) and healthier.
Median left ventricular ejection fraction for the Mini-MVr group was 55% (46-60) and 60% (55-61) for conventional MVr group
(p=0,013) (Table 1). At last follow-up, two patients died of cardiovascular disease related to mitral valve and 168 patients (89%)
showed no or grade I mitral regurgitation (Table 1). We compared cardiopulmonary bypass (CPB) and cross-clamp times of
Mini-MVr with the standard times of conventional MVr at our institution. Results showed that in the first cases Mini-MVr times
were higher than the conventional approach. Nevertheless, after the thirtieth case, CPB and cross-clamp times start lowering, and
finally, after the fiftieth case, they became shorter than the conventional MVr times. (Figure 1).
This study suggests that Mini-MVr techniques are safe, effective, and provides excellent short and long-term outcomes. Low-
volume centers can accomplish Mini-MVr results comparable to those reported worldwide. The creation of a Mini-MVr team,
lead by an experienced surgeon can help flatten the learning curve.
Giraldo-Grueso M1, Sandoval N2, Camacho J2, Pineda I3, Umaña J P2.
1 Vascular Function Research Laboratory, Fundación Cardioinfantil-Instituto de Cardiología
2 Cardiac Surgeon, Cardiac Surgery Department, Fundación Cardioinfantil-Instituto de Cardiología.
3 Epidemiology, Cardiac Surgery Department, Fudanción Cardioinfantil-Instituto de Cardiología.
Dr. Juan P Umaña is a consultant for Edward LifeScience