Long-term results after mitral valve surgery using minimally invasive versus sternotomy approach: a propensity matched comparison of a large single-center series

Abstract

Background Mitral valve (MV) surgery has traditionally been performed by conventional sternotomy (CS), but more recently minimally invasive surgery (MIS) has become another treatment option. The aim of this study is to compare short- and long-term results of MV surgery after CS and MIS. Methods This study was a retrospective propensity-matched analysis of MV operations between January 2005 and December 2015. Results Among 1357 patients, 496 underwent CS and 861 MIS. Matching resulted in 422 patients per group. The procedure time was longer with MIS than CS (192 vs. 185 min; p = 0.002) as was cardiopulmonary bypass time (133 vs. 101 min; p < 0.001) and X-clamp time (80 vs. 71 min; p < 0.001). ‘Short-term’ successful valve repair was higher with MIS (96.0% vs. 76.0%, p < 0.001). Length of hospital stay was shorter in MIS than CS patients (10 vs. 11 days; p = 0.001). There was no difference in the overall 30-day mortality rate. Cardiovascular death was lower after MIS (1.2%) compared with CS (3.8%; OR 0.30; 95%CI 0.11–0.84). The difference did not remain significant after adjustment for procedural differences (aOR 0.40; 95%CI 0.13–1.25). Pacemaker was required less often after MIS (3.3%) than CS (11.2%; aOR 0.31; 95%CI 0.16–0.61), and acute renal failure was less common (2.1% vs. 11.9%; aOR 0.22; 95%CI 0.10–0.48). There were no significant differences with respect to rates of stroke, myocardial infarction or repeat MV surgery. The 7-year survival rate was significantly better after MIS (88.5%) than CS (74.8%; aHR 0.44, 95%CI 0.31–0.64). Conclusion This study demonstrates that good results for MV surgery can be obtained with MIS, achieving a high MV repair rate, low peri-procedural morbidity and mortality, and improved long-term survival.

Safety and Efficacy of the Transaxillary Access for Minimally Invasive Mitral Valve Surgery—A Propensity Matched Competitive Analysis

“…The latter conceptually must be the same as "classic" surgery by sternotomy: an extracorporeal circulation is established and there, of course, is a need for temporary cardiac arrest. Correspondingly, several working groups showed that perfusion and aortic cross clamp time are significantly longer in minimally invasive mitral surgery, which might be a result of limited visualization, and unfamiliar hand-eye coordination [1,[22][23][24].…”

“…Nonetheless, until now, minimally invasive surgery failed to prove better outcomes by means of mortality and stroke rate compared to the classic full sternotomy approach. Scientifically approved key benefits of minimally invasive Cardiac Surgery (MICS) include reduced postoperative bleeding, less frequent transfusion, faster postoperative recovery, shorter hospital stay, fewer wound infections, and cosmetic benefits of a smaller surgical wound [1][2][3][4][5][6][7]. With regard to that, there is a reason to follow minimally invasive developments.…”

Minimally Invasive versus Conventional Mitral Valve Surgery: Procedures and Early Outcomes

“…They recommend future researches to evaluate the effect of surgeon expertise and procedural volume on patient outcomes. Most recently, Cetinkaya et al [6] demonstrated that, minimally invasive surgery provided good results for MV surgery, achieving a high MV repair rate, low peri-procedural morbidity and mortality, and improved long-term outcome. It could replace conventional sternotomy as a standard approach for MV surgery.…”

“…Many single center studies reported excellent outcome for mini-MVR. However, data are limited regarding real-world outcomes and costs [4][5][6] . Any operation uses a chest wall incision other than the standard median sternotomy is categorized as minimally invasive surgery.…”

An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery

“…However, despite the increasing adoption of MIMVS, patients with absolute or relative contraindications for MIMVS exist in daily routine cardiac surgery [ 10 , 11 ]. These certain clinical conditions are potentially harmful limitations for safe MVS via the right MT access type, making FS the sole, alternatively preferred, safe and quick access type in 45% of MV surgeries in almost all German centers [ 7 , 12 ]. Moreover, longer operative times and learning curves associated with the use of long-shafted instruments and endoscopic techniques still prevent the broad acceptance of less-invasive procedures [ 13 ].…”