Exercise Stress Echo for the Evaluation of the Outcomes of Minimally Invasive Mitral Valve Repair: A 2-year Follow-up Pilot Study

Minimally invasive mitral valve repair (MIMVr) has emerged as a promising alternative to conventional surgery procedures for addressing severe degenerative mitral regurgitation (MR). It provides early benefits such as reduced morbidity, shorter hospital stays, quicker recovery, and consistent long-term safety and efficacy. Exercise stress echocardiography (ESE) is essential for evaluating MR and pulmonary pressures during peak exercise, especially in patients with discordant symptoms and regurgitation grades at rest. ESE helps assess dynamic changes in hemodynamics and guide treatment strategies. Aims: This study evaluates the hemodynamic impacts and clinical outcomes of MIMVr using ESE at 2 years posttreatment. Settings and Design: It is a retrospective study of patients who underwent MIMVr between 2020 and 2021 and ESE-evaluated at 2 years posttreatment. Materials and Methods: In this retrospective cohort study, we compared 13 patients with 13 age-matched healthy controls. All patients underwent resting and stress echocardiography using a semi-supine bicycle ergometer, Bruce, and SIECVI protocols for MR stress-echo. Results: Preoperatively, most subjects were NYHA class II/III, with a shift to class I by 2 years postsurgery. ESE showed significant improvements in ejection fraction (61.4%–73.5%, P < 0.001) and decreased LV filling pressure (E/e’ ratio from 14.4 to 10.1, P = 0.01). MIMVr patients showed reduced heart rate, double product during stress, and no stress-induced ischemia or significant arrhythmias. Conclusions: This pilot study suggests that MIMVr provides meaningful 2-year improvements in cardiac function, approaching normal parameters. However, given the small, single-center design, these findings are primarily hypothesis-generating and warrant confirmation in larger prospective trials.