Long-Term Outcomes of Right Minithoracotomy Versus Hemisternotomy for Mitral Valve Repair

Percy, Edward; Hirji, Sameer; Yazdchi, Farhang; McGurk, Siobhan; Kiehm, Spencer; Cook, R.C.M.; Kaneko, Tsuyoshi; Shekar, Prem; Pelletier, Marc

doi:10.1177/1556984519891966

Cited by 5 publications

(7 citation statements)

References 27 publications

(36 reference statements)

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“…31 More recent studies have described no difference in mortality and stroke rate between the two groups thanks to experienced centers and better patient preoperative assessment regarding anatomy and clinical history. 13,24,29,31,32 In our study, postoperative atrial fibrillation (FA) and conduction block alteration with the need for a PM appeared more frequently in the EAC group. We have hypothesized that EABC means a no-touch technique with respect to the sinus node and left atrial roof, although, the literature lacks confirmation of this.…”

Section: Discussionmentioning

confidence: 62%

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Comparative myocardial protection of endoaortic balloon versus external clamp in minimally invasive mitral valve surgery

Grazioli

Giroletti

Graniero

et al. 2022

Journal of Cardiovascular Medicine

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AimsMinimally invasive mitral valve surgery leads to shorter postoperative recovery time, cosmetic advantages and significant pain reduction compared with the standard sternotomy approach. Both an external aortic clamp and an endoaortic balloon occlusion can be used to manage the ascending aorta and the myocardial protection. In this study, we aimed to compare these two strategies in terms of effectiveness of myocardial protection and associated early postoperative outcomes.MethodsWe investigated the retrospective records of prospectively collected data of patients treated by minimally invasive mitral valve surgery from March 2014 to June 2019. A total of 180 cases (78 in the external aortic clamp group and 102 in the endoaortic balloon clamp group) were collected. A propensity weighting analysis was adopted to adjust for baseline variables.ResultsThe endoaortic balloon clamp presented higher EuroSCORE II (higher reoperative surgery rate). The intra- and postoperative data were similar between the two groups: the postoperative troponin-I levels, peak of serum lactates and rate of myocardial infarction were also comparable. The endoaortic clamp group recorded longer operative, cardiopulmonary bypass and cross-clamp times. The external clamp group showed a higher rate of postoperative atrial fibrillation and conduction block.ConclusionsIn experienced centers, the use of the endoaortic balloon clamp is safe, reproducible and comparable to the external aortic clamp regarding the effectiveness of myocardial protection: its employment might facilitate minimally invasive mitral valve surgery.

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Section: Discussionmentioning

confidence: 62%

“…In the first report, the EABC group registered more postoperative strokes than the EAC 31 . More recent studies have described no difference in mortality and stroke rate between the two groups thanks to experienced centers and better patient preoperative assessment regarding anatomy and clinical history 13,24,29,31,32 …”

Section: Discussionmentioning

confidence: 99%

Comparative myocardial protection of endoaortic balloon versus external clamp in minimally invasive mitral valve surgery

Grazioli

Giroletti

Graniero

et al. 2022

Journal of Cardiovascular Medicine

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“…The degree to which registry data are suitable to answer questions about surgical techniques, in particular the use of auxiliary technology, is limited. Despite many studies that included a large number of patients undergoing MIMVS, there is still debate regarding the superiority of a particular mini-access route and even conventional sternotomy [ 71 ]. A recent study which included the same mitral valve surgery data from the NHR concluded that based on an analysis of registry data there was no reason to assume superiority of MIMVS in general [ 72 ].…”

Section: Discussionmentioning

confidence: 99%

At the Crossroads of Minimally Invasive Mitral Valve Surgery—Benching Single Hospital Experience to a National Registry: A Plea for Risk Management Technology

Cocchieri

Wetering

Tuijl

et al. 2022

JCDD

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Almost 30 years after the first endoscopic mitral valve repair, Minimally Invasive Mitral Valve Surgery (MIMVS) has become the standard at many institutions due to optimal clinical results and fast recovery. The question that arises is can already good results be further improved by an Institutional Risk Management Performance (IRMP) system in decreasing risks in minimally invasive mitral valve surgery (MIMVS)? As of yet, there are no reports on IRMP and learning systems in the literature. (2) Methods: We described and appraised our five-year single institutional experience with MIMVS in isolated valve surgery included in the Netherlands Heart Registry (NHR) and investigated root causes of high-impact complications. (3) Results: The 120-day and 12-month mortality were 1.1% and 1.9%, respectively, compared to the average of 4.3% and 5.3% reported in the NHR. The regurgitation rate was 1.4% compared to 5.2% nationwide. The few high-impact complications appeared not to be preventable. (4) Discussion: In MIMVS, freedom from major and minor complications is a strong indicator of an effective IRMP but remains concealed from physicians and patients, despite its relevance to shared decision making. Innovation adds to the complexity of MIMVS and challenges surgical competence. An IRMP system may detect and control new risks earlier. (5) Conclusion: An IRMP system contributes to an effective reduction of risks, pain and discomfort; provides relevant input for shared decision making; and warrants the safe introduction of new technology. Crossroads conclusions: investment in machine learning and AI for an effective IRMP system is recommended and the roles for commanding and operating surgeons should be considered.

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“…1). [14][15][16][17][18][19][20][21][22][23][24] Only 1 study was randomized, and 2 studies were multicentric and prospective. The Supplemental Tables present the study characteristics, patient characteristics, baseline New York Heart Association functional status, underlying mitral valve pathology, surgical techniques applied during the procedure, and types of cannulations during sternal-sparing MVRp.…”

Section: Study Selection and Patient Characteristicsmentioning

confidence: 99%

Long-Term Outcomes of Sternal-Sparing Versus Sternotomy Approaches for Mitral Valve Repair: Meta-Analysis of Reconstructed Time-to-Event Data

Sá

Jacquemyn

Erten

et al. 2023

Innovations�(Phila)

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Objective: Since there are concerns about the durability of mitral valve repair (MVRp) with minimally invasive techniques in patients with mitral regurgitation (MR), we aimed to evaluate the long-term outcomes of these sternal-sparing approaches when compared with conventional approaches with sternotomy in patients undergoing MVRp. Methods: We performed a systematic review according to a preestablished protocol and performed a pooled analysis of Kaplan–Meier–derived reconstructed time-to-event data from studies with longer follow-up comparing sternal-sparing versus sternotomy approaches for MVRp. Our outcomes of interest were survival, freedom from recurrent MR, and freedom from reoperation. Results: Eleven studies met our eligibility criteria comprising 7,596 patients with follow-up (sternal sparing, n = 4,246; sternotomy, n = 3,350). Patients who underwent sternal-sparing MVRp had a significantly lower risk of mortality over time compared with patients who underwent MVRp with sternotomy (hazard ratio [HR] = 0.29, 95% confidence interval [CI]: 0.23 to 0.36, P < 0.001) in the overall analysis. However, we found no statistically significant difference between the groups in the sensitivity analysis with adjusted populations (HR = 0.85, 95% CI: 0.63 to 1.15, P = 0.301). Regarding the outcomes freedom from recurrent MR and freedom from reoperation, we found no statistically significant differences between the groups in the follow-up in both overall and sensitivity analyses. Conclusions: In comparison with MVRp with sternotomy approaches, sternal-sparing MVRp was not associated with worse outcomes in terms of survival, recurrent MR, and reoperations over time.

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Long-Term Outcomes of Right Minithoracotomy Versus Hemisternotomy for Mitral Valve Repair

Cited by 5 publications

References 27 publications

Comparative myocardial protection of endoaortic balloon versus external clamp in minimally invasive mitral valve surgery

Comparative myocardial protection of endoaortic balloon versus external clamp in minimally invasive mitral valve surgery

At the Crossroads of Minimally Invasive Mitral Valve Surgery—Benching Single Hospital Experience to a National Registry: A Plea for Risk Management Technology

Long-Term Outcomes of Sternal-Sparing Versus Sternotomy Approaches for Mitral Valve Repair: Meta-Analysis of Reconstructed Time-to-Event Data

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