Risk-related clinical outcomes after minimally invasive mitral valve surgery: insights from the Mini-Mitral International Registry

Abstract

Objective With the popularization of catheter-based mitral valve procedures, evaluating risk-specific differentiated clinical outcomes after contemporary mitral valve surgery is crucial. In this study, we assessed the operative results of minimally invasive mitral valve operations across different patient risk profiles and evaluated the value of EuroSCORE II predicted risk of mortality model for risk prediction, in the large cohort of Mini-Mitral International Registry (MMIR). Methods The MMIR database was used to analyze mini-mitral operations between 2015 and 2021. Patients were categorized as low- (<4%), intermediate- (4% to < 8%), high- (8% to < 12%) and extreme risk (≥12%) according to EuroSCORE II. The observed to expected (O: E) mortality ratio was calculated for each risk group. Results A total of 6541 patients were included in the analysis. Of those, 5546 (84.8%) were classified as low risk, 615 (9.4%) as intermediate risk, 191 (2.9%) as high risk and 189 (2.9%) as extreme risk. Overall operative mortality and stroke rates were 1.7% and 1.4%, respectively, and were significantly associated with patient’s risk. The observed mortality was significantly lower than expected -according to the EuroSCORE II- in all risk categories (O: E ratio < 1). Conclusions The present study provides an international contemporary benchmark for operative outcomes after minimally invasive mitral surgery. Operative results were excellent in low-, intermediate- and high risk patients, but were less satisfactory in extreme risk. The EuroSCORE II model overestimated the in-hospital mortality. We believe findings from the MMIR may assist surgeons and cardiologists in clinical decision-making and treatment allocation for patients with mitral valve disease.

Implementation of Endoscopic Minimally Invasive Mitral Valve Replacement Surgery With Automated Suturing Technology

“…4 A landmark effort by Berretta et al has established an international standard for minimally invasive mitral valve surgery, demonstrating exceptional outcomes across low-risk, intermediate-risk, and high-risk patient groups based on data from the Mini-Mitral International Registry. 10 Despite the compelling advantages and growing body of evidence supporting gentler sternal-sparing surgical techniques, integration into mainstream cardiac surgery has been slow. Initial hesitancy among surgeons stemmed from concerns about a steep learning curve and prolonged CPB and cross-clamp times, which were perceived as additional risks to patients and have been cited as independent predictors of postoperative morbidity and mortality.…”

“… 4 A landmark effort by Berretta et al has established an international standard for minimally invasive mitral valve surgery, demonstrating exceptional outcomes across low-risk, intermediate-risk, and high-risk patient groups based on data from the Mini-Mitral International Registry. 10 …”

Pacemaker implantation after concomitant tricuspid valve repair in patients undergoing minimally invasive mitral valve surgery: Results from the Mini-Mitral International Registry

“…According to the protocol of the registry, all patients who underwent surgery during the inclusion period had to be provided by the participating centers. 4 Perioperative characteristics and in-hospital outcomes of 7513 consecutive patients were collected according to Mitral Valve Academic Research Consortium definitions. 5 Patients with pacemaker implantation before MV surgery, endocarditis, and the need for tricuspid valve (TV) replacement were excluded, resulting in 6722 patients to be included in this analysis.…”

“…The protocol of the registry, description of the data source, and definition have been published previously. 4 Ethic boards of all centers approved participation in the registry and this analysis.…”

Adoption of minimally invasive mitral valve surgery: single-centre implementation experience in Vietnam

“…Our commitment to excellence extends beyond our hospital walls as we actively contribute to international reports, sharing our insights and experiences with the broader medical community 8 , 13 , 29 . Additionally, to foster collaboration and enhance scientific publication, we ensure that our MIMVS data are regularly updated with the data from the mini-mitral international registry, promoting the sharing of valuable information and facilitating international cooperation in the field 30 , 31 . Through these efforts, we contribute to the advancement of medical knowledge, ultimately benefiting patients around the world.…”