[Minimally invasive trans-axillary approach and ultra-fast-track management: a new paradigm for mitral valve disease treatment].

BACKGROUND

The introduction of transcatheter procedures has focused on patient expectations for treatments with a less invasive approach and faster recovery. The aim of this study was to assess the short- and medium-term results in patients who underwent trans-axillary mitral valve repair with application of the ultra-fast-track protocol.

METHODS

Data from 431 patients undergoing isolated trans-axillary mitral valve repair or associated with tricuspid valve treatment between January 2018 and December 2023 were prospectively collected.

RESULTS

The mean age of the population was 63 ± 11 years and the average EuroSCORE II was 1.21 ± 1%. Mitral valve repair for degenerative mitral regurgitation was performed in 93.3% of cases. In 52 cases (12.6%) concomitant tricuspid valve repair was performed. The 30-day mortality rate was 0.2% (n=1), the postoperative stroke rate was 0.2% (n=1). A total of 351 patients (81.4%) were extubated within 6 h of the procedure; in 218 cases (50.6%) extubation occurred in the operating room, at the end of the surgical treatment. Overall, 70.8% (n=305) of patients left the intensive care unit on the first postoperative day; 222 patients (51.6%) were discharged home without the need for any further rehabilitation. Postoperative mitral regurgitation was absent/negligible in 97% of cases (n=418). Survival at 1 year and 5 years was 98.9% and 97.9%, respectively.

CONCLUSIONS

The trans-axillary approach for mitral valve repair was associated with low rates of in-hospital mortality and postoperative complications. The application of our ultra-fast-track protocol in more than 80% of cases allowed early extubation, short intensive care unit stay and reduced hospitalization with a high rate of patients able to be discharged home with no need of any further period of rehabilitation. The medium-term outcomes support the safety and efficacy profile of the trans-axillary approach.