Minimally invasive versus conventional mitral valve surgery: A propensity-matched comparison

Svensson, Lars; Atik, Fernando Antibas; Cosgrove, Delos M.; Blackstone, Eugene H.; Rajeswaran, Jeevanantham; Krishnaswamy, Gita; Jin, Ung Sik; Gillinov, A. Marc; Griffin, Brian P.; Navia, José L.; Mihaljević, Tomislav; Lytle, Bruce W.

doi:10.1016/j.jtcvs.2009.09.038

Cited by 193 publications

(183 citation statements)

References 34 publications

(52 reference statements)

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“…Initial experiences with thoracoscopic mitral valve surgery documented mortality rates near 10% (11). However, more recent studies, including our own, reproducibly demonstrate mortality rates less than 1%, particularly in the case of degenerative mitral valve disease (4,5,7,12). Furthermore, a recent metaanalysis that pooled over 20,000 patients reported no difference in operative mortality between video-assisted and conventional sternotomy approaches (13).…”

Section: Comparison To Sternotomy Approachmentioning

confidence: 62%

“…Intermediate and long-term survival is equally encouraging. Propensity score matched comparisons of minimally invasive and sternotomy approaches to mitral valve surgery reveal similar survival up to a decade after surgery (5)(6)(7). In our analysis of 402 well-matched patient pairs with mitral regurgitation of any etiology, 9-year survival was 96% after thoracoscopic mitral valve repair, and 89% following the conventional approach (7).…”

Section: Comparison To Sternotomy Approachmentioning

confidence: 70%

“…Therefore, thoracoscopic mitral valve surgery must be as safe, effective, and durable as the traditional "open" approach. To date, no comparison study has shown a significant difference in operative mortality when comparing minimally invasive mitral valve surgery to that through median sternotomy (4)(5)(6)(7)(8)(9)(10). Initial experiences with thoracoscopic mitral valve surgery documented mortality rates near 10% (11).…”

Section: Comparison To Sternotomy Approachmentioning

confidence: 99%

See 2 more Smart Citations

Is minimally invasive thoracoscopic surgery the new benchmark for treating mitral valve disease?

Goldstone¹,

Woo²

2016

Ann. Cardiothorac. Surg.

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The treatment of mitral valve disease remains dynamic; surgeons and patients must now choose between many different surgical options when addressing mitral regurgitation and mitral stenosis. Notably, advances in imaging and surgical instrumentation allow surgeons to perform less invasive mitral valve surgery that spares the sternum. With favorable long-term data now emerging, we compare the benefits and risks of thoracoscopic mitral valve surgery with that through conventional sternotomy or surgery that is robotassisted.

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Section: Comparison To Sternotomy Approachmentioning

confidence: 62%

Section: Comparison To Sternotomy Approachmentioning

confidence: 70%

Section: Comparison To Sternotomy Approachmentioning

confidence: 99%

See 1 more Smart Citation

Is minimally invasive thoracoscopic surgery the new benchmark for treating mitral valve disease?

Goldstone¹,

Woo²

2016

Ann. Cardiothorac. Surg.

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“…Whilst, procedures to address leaflet tethering such as chordal cutting, Dor Procedure, papillary muscle slings, and relocation have been described, these are difficult to standardize [46]. In fact, differing surgical approaches using right thoracotomy or minimally invasive approach for MVS have been shown to improve safety and efficacy endpoints [47]. MVR has been advocated over MVRP, but routine sparing of the sub-valvular apparatus has resulted in reproducible reductions in operative mortality after MVRP [48].…”

Section: Discussionmentioning

confidence: 99%

MitraClip for severe symptomatic mitral regurgitation in patients at high surgical risk

Philip

Athappan

Tuzcu

et al. 2014

Cathet Cardio Intervent

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Background: The optimal treatment of patients with severe mitral regurgitation (MR) at high surgical risk (HSR) is unknown. Recently, the EVEREST II (Endovascular Valve Edgeto-Edge Repair) High Risk Study suggested MitraClip (MC) was a safe and effective treatment option. Methods: We performed a search strategy for MC or mitral valve surgery (MVS) in patients at HSR for surgical mortality (logistic EuroSCORE >18 or STS score > 10) using Medline databases, proceedings of international meetings, and the STS database. We identified 21 studies utilizing MC (n 5 3,198) and MVS (n 5 3,265, >90% from the STS database) from 2003 to 2013. Information about patient characteristics, surgical risk, and 30-day and 1-year outcomes were extracted. Results: Patients who underwent MC or MVS had a mean age of 74 6 10 years with no differences in surgical risk, NYHA class, or MR grade (P 5 0.46). Technical success was achieved in 96% of patients undergoing MC versus 98% in the MVS group (P 5 0.45). Patients undergoing MC were treated with one or two MC in 90% (n 5 2,878) with only a few requiring repeat MC (0.4%, n 5 13) or mitral surgery (0.3%, n 5 52) at 30 days. The pooled event rates for mortality was 3.2% (95% CI [2.5-4.2]), stroke was 1.1% (95% CI [0.7-0.2]) at 30 days. At 31 days to 1 year, the pooled event rate for mortality was 13.0% [95% CI (9-18.3)], stroke was 1.6% [95% CI (0.8-3.2)], and repeat MVS was 1.3% [95% CI (0.7-2.6)] with the majority of patients in the mild/moderate MR grade and NYHA class after MC. The 30-day event rates for mortality and stroke were 16.8% (95% CI [14][15][16][17][18][19]) and 4.5% (95% CI [3.9-5.3]) after MVS, respectively. Conclusion: Based on high risk MC studies and high risk MVS data predominantly from STS database, patients with severe MR who are at HSR can be effectively treated with MC or MVS. MC can be safely implanted in high risk patients with relatively low mortality and stroke risk. V C 2014 Wiley Periodicals, Inc.

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“…Postoperative pain scores were lower (P<0.0001) after minimally invasive surgery. [43] This accumulating experience with MIMSV encouraged surgeons to extend the application of the minimally invasive techniques now to high-risk patients, redo surgeries and concomitant double or triple valve procedures [44], reducing the need for full median sternotomy. Also when it comes to combined coronary artery and mitral valve diseases, a hybrid approach of percutaneous coronary intervention and MIMVS has been suggested as an alternative to the standard approach of combined coronary artery bypass grafting and mitral valve operation through median sternotomy.…”

Section: Current Status Of Mimvsmentioning

confidence: 99%

Minimally Invasive Mitral Valve Surgery: An Update

Alkady¹

2017

IJCTS

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Abstract:Minimally invasive mitral valve surgery (MIMVS) was introduced in the mid-1990s to refer to a variety of surgical techniques that avoid full sternotomy through smaller or alternative chest wall incisions, as an attempt to reduce complications, but at the same time preserve outcomes of the full sternotomy approach. In this review, different aspects of MIMVS are discussed in relation to its approaches (right parasternal incision, lower ministernotomy, right anterolateral minithoracotomy and left posterior minithoracotomy) as well as strategies (mini-incisions, video-assistance, video direction with robotic assistance and telemanipulation) passing through more than 2 decades of continuous evolution. In the current practice MIMVS shows similar outcome to conventional surgery with even more superior results regarding blood loss, ICU and hospital stay, as well as functional recovery. The accumulating experience with MIMVS encouraged surgeons to extend the application of these techniques to high-risk patients, redo surgeries, concomitant double or triple valve procedures as well as combined coronary artery and mitral valve diseases in a hybrid approach, reducing the need for full median sternotomy. In addition there is an emerging trend of transcatheter valve implantation in the mitral position with small reports of valve-in valve or valve-in-ring implantation as well as valve replacement in case of severe MAC. This new trend may establish itself in the future as a modality in treating native mitral valve diseases in high risk patients. Therefore it is recommended for cardiac centers to build up a program for MIMVS in order to fulfill the recent requirements of cardiac surgery.

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Minimally invasive versus conventional mitral valve surgery: A propensity-matched comparison

Cited by 193 publications

References 34 publications

Is minimally invasive thoracoscopic surgery the new benchmark for treating mitral valve disease?

Is minimally invasive thoracoscopic surgery the new benchmark for treating mitral valve disease?

MitraClip for severe symptomatic mitral regurgitation in patients at high surgical risk

Minimally Invasive Mitral Valve Surgery: An Update

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