Right Minithoracotomy Versus Median Sternotomy for Mitral Valve Surgery: A Propensity Matched Study

Tang, Paul C.; Onaitis, Mark W.; Gaca, Jeffrey G.; Milano, Carmelo A.; Stafford‐Smith, Mark; Glower, Donald D.

doi:10.1016/j.athoracsur.2015.04.027

“…A recurrent finding of many studies on this topic is the notification of longer aortic cross-clamp and cardiopulmonary bypass times [5][6][7][8][9][10][11] . The adverse relationship between these factors and secondary organ dysfunction is well-known in the field of cardiac surgery [16][17] .…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, this 'port-access' surgery has become the preferred technique for mitral and/or tricuspid valve surgery in many centers. Several studies pointed repetitively to the obvious benefits as an improved cosmetic result, a shorter hospital stay, quicker socio-economic reintegration and decreased need for blood products, whilst the main surgical end-points in terms of quality of mitral repair and morbidity as mortality were commonly maintained once the inevitable learning curve has been surpassed [4][5][6][7][8][9][10][11] . Hence, even in experienced hands, port-access MV surgery is associated with longer duration of cardiopulmonary bypass and aortic cross-clamp time, known of having an adverse effect on postoperative morbidity and mortality due to secondary organ dysfunction 5,6,8 .…”

Section: Introductionmentioning

confidence: 99%

Analysis of clinical outcome and postoperative organ function effects in a propensity-matched comparison between conventional and minimally invasive mitral valve surgery

Missault

¹

,

Causenbroeck

²

,

Vandewiele

³

et al. 2020

Preprint

1

0

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Background: Minimally invasive mitral valve(MV) surgery(MIVT) is increasingly performed with excellent clinical outcome, despite longer procedural times. This study analyzes clinical outcome and secondary organ function effects in a propensity-matched comparison with conventional MV surgery. Methods and Results: Out of 439 patients undergoing MV surgery from January 2005 to May 2017, 345 patients were included after propensity-matching: 95 sternotomy patients and 250 MIVT patients. Endpoints focused on survival, quality of MV repair and organ function effects through analysis of biomarkers and functional parameters. Despite longer cardiopulmonary bypass(sternotomy: 96.0(IQR34)min-MIVT:134.0(IQR42)min, p<0.001) and cardioplegic arrest times(sternotomy: 61.0(IQR26)min-MIVT:87.0(IQR34)min, p<0.001), no differences in survival nor complication rate were found. Effect on renal function(creatinine, p=0.751-ureum, p=0.538-glomerular filtration, p=0.848), myocardial damage by troponine I level (sternotomy:1.8±3.9ng/ml-MIVT:1.2±1.3ng/ml, p=0.438) and ventilatory support > 24 hours(sternotomy:5.5%-MIVT:9.5%, p=0.240) were comparable. Systemic inflammatory reaction by postoperative CRP count was markedly lower for MIVT(p<0.001). Increased rhadomyolysis was found after MIVT surgery, based on significant elevation of creatinine-kinase levels(sternotomy: 431±237U/L-MIVT: 701±595U/L, p<0.001). Conclusion: Despite an inherent learning curve, minimally invasive MV surgery guarantees a clinical outcome and MV repair quality, at least non-inferior to those of MV surgery via sternotomy. Notwithstanding longer cardiopulmonary bypass and cardiac arrest times, the impact on secondary organ function is negligible, excepted for a lower systemic inflammatory response. The postoperative increase of CK-enzymes suggestive for enhanced rhabdomyolysis needs to be accounted when procedural times tend to exceed the critical time threshold for severe limb ischemia. Analysis of clinical outcome and postoperative organ function effects in a propensity-matched comparison between conventional and minimally invasive mitral valve surgery

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“…Several studies pointed repetitively to the obvious benefits as an improved cosmetic result, a shorter hospital stay, quicker socioeconomic reintegration and decreased need for blood products, whilst the main surgical end-points in terms of quality of mitral repair and morbidity as mortality were commonly maintained once the inevitable learning curve has been surpassed. [4][5][6][7][8][9][10][11] Hence, even in experienced hands, port-access MV surgery is associated with longer duration of cardiopulmonary bypass and aortic cross-clamp time, known of having an adverse effect on postoperative morbidity and mortality due to secondary organ dysfunction. 5,6,8 The purpose of this study is to compare the clinical outcome of MV surgery performed through port-access and conventional sternotomy in a propensity-matched cohort, with additional focus on secondary organ function by analysis of organ-specific biomarkers and/or other functional outcome parameters.…”

Section: Introductionmentioning

confidence: 99%

“…A recurrent finding of many studies on this topic is the notification of longer aortic cross-clamp and cardiopulmonary bypass times. [5][6][7][8][9][10][11] The adverse relationship between longer procedural times and secondary organ dysfunction is well-known in the field of cardiac surgery. 16,17 Through analysis of specific organ function biomarkers, Regarding the systemic inflammatory reaction, CRP counts remained largely inferior during the first 48 h after port-access MV surgery than after conventional sternotomy.…”

mentioning

confidence: 99%

Analysis of clinical outcome and postoperative organ function effects in a propensity‐matched comparison between conventional and minimally invasive mitral valve surgery

Missault

¹

,

Causenbroeck

²

,

Vandewiele

³

et al. 2020

View full text Add to dashboard Cite

Background: Minimally invasive mitral valve (MV) surgery (MIVT) is increasingly performed with excellent clinical outcome, despite longer procedural times. This study analyzes clinical outcomes and effects on secondary organ functions in a propensity-matched comparison with conventional MV surgery. Methods and Results: Out of 439 patients undergoing MV surgery from January 2005 to May 2017, 233 patients were included after propensity-matching: 90 sternotomy patients and 143 MIVT patients. Endpoints focused on survival, quality of MV repair, and organ function effects through analysis of biomarkers and functional parameters. Regardless of longer cardiopulmonary bypass (sternotomy: 101(IQR33) min-MIVT:143(IQR45) min, p < .001) and cardioplegic arrest times (sternotomy: 64(IQR25) min-MIVT:90(IQR34) min, p < .001), no differences in survival nor complication rate were found. Effect on renal function(creatinine, p = .751ureum, p = .538glomerular filtration, p = .848), myocardial damage by troponine I level (sternotomy:1.8 ± 3.9 ng/ml-MIVT:1.2 ± 1.3 ng/ml, p = .438) and prolonged ventilatory support >24 h (sternotomy:5.5%-MIVT:8.4%, p = .417) were comparable. The systemic inflammatory reaction by postoperative C-reactive protein count was markedly lower for MIVT(p < .001). Increased rhadomyolysis was found after MIVT surgery, based on a significant elevation of creatinine-kinase levels

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“…Several institutional reports revealed outstanding results as a minimally invasive surgical approach provided to be safe and effective. Furthermore, propensity-matched studies showed comparable early and midterm results between right mini-thoracotomy access and conventional sternotomy approach [11][12][13][14]. However, all these experiences collaterally highlighted that patients in sternotomy surgery cohorts had a higher preoperative risk score and a higher prevalence of redo procedures, rheumatic disease, and MV replacement.…”

mentioning

confidence: 99%

Minimally invasive tricuspid valve surgery without caval occlusion: Short and midterm results

Margari

¹

,

Malvindi

²

,

Santis

³

et al. 2021

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Objective: The use of minimally invasive or transcatheter interventions rather than standard full sternotomy operations to treat tricuspid valve (TV) disease is increasing. The debate however is still open regarding venous drainage management during cardiopulmonary bypass (CPB) and wheatear or not superior and inferior vena cava should be occluded during the opening of the right atrium to avoid air entrance in the venous line. The aim of the present study is to report operative outcomes and midterm follow-up results of minimally invasive TV surgery performed without caval occlusion. Methods: A retrospective outcome evaluation from institutional records was performed with prospective data entry. Considered were consecutive patients who underwent right mini-thoracotomy TV surgery isolated or combined with mitral valve surgery during the period from June 2013 to February 2020. A telephone and echocardiographic follow-up was performed. Results: During the study period, 68 consecutive patients underwent minimally invasive TV surgery without occlusion of cava veins. The mean age was 69 ± 14 years and 48 (70%) were female. All operations were performed safely without airlock during CPB. A perioperative cerebral stroke occurred in one patient. The survival at a 5-and 8-year follow-up was 100% and 79%, respectively. No severe tricuspid regurgitation was evident at echocardiographic follow-up. Conclusion: Our results show that performing tricuspid surgery without caval occlusion is safe. The air was captured by the active vacuum drainage system without causing damage. Midterm follow-up data confirm that a minimally invasive approach does not alter the quality of surgery.

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Right Minithoracotomy Versus Median Sternotomy for Mitral Valve Surgery: A Propensity Matched Study

Cited by 23 publications

References 28 publications

Analysis of clinical outcome and postoperative organ function effects in a propensity-matched comparison between conventional and minimally invasive mitral valve surgery

Analysis of clinical outcome and postoperative organ function effects in a propensity-matched comparison between conventional and minimally invasive mitral valve surgery

Analysis of clinical outcome and postoperative organ function effects in a propensity‐matched comparison between conventional and minimally invasive mitral valve surgery

Minimally invasive tricuspid valve surgery without caval occlusion: Short and midterm results

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