Early outcomes of mitral valvuloplasty by minimally invasive surgery or sternotomy

Abstract

Background Disagreement exists regarding methods for repair of the mitral valve. We compared early outcomes of mitral valvuloplasty by a minimally invasive technique and by a median sternotomy. Methods The data of 507 patients (mean age 47.9 ± 15.2 years) undergoing mitral valvuloplasty from January 2015 to June 2018 were analyzed retrospectively. In the study group ( n = 225), mitral valvuloplasty via a totally thoracoscopic approach was performed by a single surgeon. In the control group ( n = 282), mitral valvuloplasty via the traditional median sternotomy was carried out by other cardiac surgeons in our hospital. Clinical data, surgical results, and follow-up findings in the two groups were comparatively analyzed. Results In the study group, the blood transfusion rate (5.3% vs. 20.9%, p < 0.05) and incidences of poor wound healing (0 vs. 5.3%, p < 0.05) and respiratory tract infection (4.4% vs. 16.3%, p < 0.05) were lower, and postoperative hospitalization was shorter (5.9 ± 4.0 vs. 10.7 ± 8.4 days, p < 0.05). Within 30 days after surgery, no patient died in the study group while one died in the control group. The duration of follow-up was 12–36 months (mean 22.9 ± 8.8 months). During follow-up, there were 1 and 0 cases of redo surgery and 1 and 3 deaths in the study group and control group, respectively. Conclusion Mitral valvuloplasty via a minimally invasive approach is superior to the traditional median sternotomy in terms of early outcomes, especially when performed by experienced surgeons.

Comparative efficacy of five surgical methods in the treatment of mitral regurgitation: A systematic review and network meta‐analysis

“…There were 1892 relevant articles retrieved ultimately, among which 272 were duplicate articles. After screening layer by layer, 31 4–33 articles were finally included, including 24 in English and 7 in Chinese, including 18 propensity matching studies and 4 master's thesis. Figure 1 shows the screening process.…”

Innovations and Developments in Totally Thoracoscopic Cardiac Procedures

“…A propensity-score matching study comparing a median sternotomy with TTCS for mitral valve replacement showed fewer transfusions, less wound infections, faster recovery, faster return to work, and greater satisfaction with the incision compared with a median sternotomy [39]. Likewise, mitral valvuloplasty via TTCS is superior to those via median sternotomy in terms of the rate of blood transfusion, and the incidence of sternal and wound complications [40]. Although there was no survival difference at 7-year follow-up, it has been demonstrated that the perioperative outcomes including tracheal intubation, chest tube drainage, and transfusion in the patients who underwent re-operative mitral valve replacement via TTCS is improved [41].…”

Longitudinal Outcomes Following Surgical Repair of Primary Mitral Regurgitation

“…The durability of repair through long-term follow-up has also been equivocal between conventional and minimally invasive groups. Nonetheless, here is a lack of robust RCTs comparing the longitudinal outcomes between these approaches [ 39 , 40 , 41 , 42 , 43 ].…”