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OBJECTIVES: Minimally invasive mitral valve surgery (mini-MVR) has numerous associated benefits. However, many studies fail to include higher risk patients. We hypothesized that a minimally invasive approach in a representative cohort provides excellent outcomes with reduced resource utilization. METHODS: Mitral valve surgical records from 2011-2016 were paired with institutional financial records. Patients were stratified by approach and propensity-score matched to balance preoperative difference. The primary outcomes of interest were resource utilization including cost, discharge to a facility, and readmission. RESULTS: A total of 478 patients underwent mitral surgery (21% mini-MVR) and were balanced after matching (n=74 per group) with 18% of patients having non-degenerative mitral disease. Outcomes were excellent with similar rates of major morbidity (9.5% mini-MVR vs 10.8% conventional, p=0.78). Mini-MVR cases had lower rates of transfusion (11% vs 27%, p=0.01) and shorter ventilator times 3.7 vs 6.0 hrs (p

Total chordal preservation is the standard for mitral valve replacement to maintain long-term left ventricular geometry. Whereas it is appropriate for functional and degenerative mitral regurgitation, the role of chordal sparing in rheumatic valve disease is less well understood, with limited evidence supporting total chordal sparing. Inasmuch as this autoimmune disease affects the subvalvular apparatus in addition to the leaflets, it can be expected to continue after surgical repair. Here we present 2 patients who experienced adverse events associated with total chordal sparing mitral replacement as a result of disease progression with rapid fibrous growth causing inflow obstruction and early prosthetic valve failure.