Minimally invasive mitral valve surgery without aortic cross-clamping and with femoral cannulation is not associated with increased risk of stroke compared with traditional mitral valve surgery: a propensity score-matched analysis

Abstract OBJECTIVES An increasing number of mitral valve operations are performed using minimally invasive procedures. The initiation of a minimally invasive mitral valve surgery programme constitutes a unique opportunity to study outcome differences in patients with similar characteristics operated on through a sternotomy versus a minimally invasive procedure. The goal of this study was to compare short-term outcomes of patients undergoing mitral valve surgery before versus those having surgery after the introduction of a minimally invasive programme. METHODS The single-centre study included mitral valve procedures performed through a sternotomy or with a minimally invasive approach between January 2012 and May 2019. Propensity score matching was performed to reduce selection bias. RESULTS A total of 605 patients (294 sternotomy, 311 minimally invasive) who underwent mitral valve surgery were included in the analysis. Propensity score matching resulted in 251 matched pairs. In the propensity score-matched analysis, minimally invasive procedures had longer extracorporeal circulation duration (149 ± 52 vs 133 ± 57 min; P = 0.001) but shorter aortic occlusion duration (97 ± 36 vs 105 ± 40 min, P = 0.03). Minimally invasive procedures were associated with a lower incidence of reoperation for bleeding (2.4% vs 7.2%; P = 0.012), lower need for transfusion (19.1% vs 30.7%; P = 0.003) and shorter in-hospital stay (5.0 ± 2.7 vs 7.2 ± 4.6 days; P < 0.001). The 30-day mortality was low in both groups (0.4% vs 0.8%; P = 0.56). CONCLUSIONS Minimally invasive mitral valve surgery was associated with short-term outcomes comparable to those with procedures performed through a sternotomy. Initiating a minimally invasive mitral valve programme with a limited number of surgeons and a well-executed institutional selection strategy did not confer an increased risk for adverse events.

Download Full-text

Propensity score–adjusted comparison of thoracoscopic periareolar versus video-assisted approaches for minimally invasive mitral valve surgery

Kardiologia Polska ◽

10.33963/kp.15535 ◽

2020 ◽

Author(s):

Piotr Suwalski ◽

Radoslaw Smoczynski ◽

Mariusz Kowalewski ◽

Anna Witkowska ◽

Dominik Drobinski ◽

...

Keyword(s):

Mitral Valve ◽

Propensity Score ◽

Minimally Invasive ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Video Assisted

Download Full-text

Propensity-matched analysis of minimally invasive approach versus sternotomy for mitral valve surgery

Heart ◽

10.1136/heartjnl-2018-314049 ◽

2018 ◽

Vol 105 (10) ◽

pp. 783-789 ◽

Cited By ~ 14

Author(s):

Stuart W Grant ◽

Graeme L Hickey ◽

Paul Modi ◽

Steven Hunter ◽

Enoch Akowuah ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Mitral Valve ◽

Propensity Score ◽

Minimally Invasive ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Minimally Invasive Approach ◽

Short Term ◽

Invasive Approach ◽

Free Survival

ObjectiveThe objective of this multicentre study was to compare short-term and midterm outcomes between sternotomy and minimally invasive approaches for mitral valve surgery.MethodsData for all mitral valve procedures with or without concomitant tricuspid atrial fibrillation surgery were analysed from three UK hospitals between January 2008 and December 2016. To account for selection bias between minimally invasive approach and sternotomy, one-to-one propensity score calliper matching without replacement was performed. The main outcome measure was midterm reintervention free survival that was summarised by the Kaplan-Meier estimator and compared between treatment arms using the stratified log-rank test.ResultsA total of 2404 procedures (1757 sternotomy and 647 minimally invasive) were performed during the study period. Propensity score matching resulted in 639 matched pairs with improved balance postmatching in all 31 covariates (absolute standardised mean differences <10%). Despite longer procedural times patients who underwent minimally invasive surgery had a lower need for transfusion (20.5%vs14.4%, p=0.005) and reduced median postoperative length of stay (7 vs 6 days, p<0.001). There were no statistically significant differences in the rates of in-hospital mortality or postoperative stroke. Reintervention-free survival at 8 years was estimated as 86.1% in the minimally invasive group and 84.1% in the sternotomy group (p=0.40).ConclusionsMinimally invasive surgery is associated with excellent short-term outcomes and comparable midterm outcomes for patients undergoing mitral valve surgery. A minimally invasive approach should be considered for all patients who require mitral valve intervention and should be the standard against which transcatheter mitral techniques are compared.

Download Full-text

Minimally Invasive Mitral Valve Surgery Does Not Limit Sophisticated Repair Technique: Propensity Score Matched Analysis

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2019.08.117 ◽

2019 ◽

Vol 229 (4) ◽

pp. S47

Author(s):

Sivan G. Marcus ◽

Greg J. Haro ◽

Alexander G. Merriman ◽

Carolyn G. Clary ◽

Tobias G. Deuse

Keyword(s):

Mitral Valve ◽

Propensity Score ◽

Minimally Invasive ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Repair Technique

Download Full-text

Clinical outcomes associated with retrograde arterial perfusion in minimally invasive mitral valve surgery: a systematic review

Perfusion ◽

10.1177/0267659120929181 ◽

2020 ◽

Vol 36 (1) ◽

pp. 11-20

Author(s):

Daniel JP Burns ◽

Rashmi Birla ◽

Hunaid A Vohra

Keyword(s):

Renal Failure ◽

Mitral Valve ◽

Minimally Invasive ◽

Clinical Outcomes ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Cochrane Library ◽

Arterial Perfusion ◽

Risk Estimates ◽

Increased Risk

Introduction: Given several reports of an increased neurologic risk with retrograde arterial perfusion in minimally invasive mitral valve surgery, we sought to identify and synthesize the best available evidence on the influence of perfusion strategy on post-operative clinical outcomes in this population. Methods: A systematic search of PubMed, EMBASE, MEDLINE, and Cochrane library databases was performed to identify publications comparing clinical outcomes associated with antegrade and retrograde arterial perfusion in minimally invasive mitral valve surgery. Pre-specified outcomes of interest were neurologic events, mortality, and renal failure. The search was performed by two independent reviewers, with data abstraction following. Results: Seven observational studies were included in this review, with a total patient population of 5,385. Six were retrospective cohort in design, with a single small prospective cohort study identified. When available, adjusted publication-specific risk estimates were abstracted and included preferentially over unadjusted or reviewer-derived risk estimates. Meta-analysis was felt to be heavily flawed in the context of few small studies identified and was not performed. In adjusted estimates, there appeared to be an increased risk of neurologic complications with retrograde arterial perfusion. There was a null pattern apparent between arterial perfusion strategy and each of 30-day mortality and renal failure. Conclusion: Retrograde arterial perfusion in minimally invasive mitral valve surgery may be associated with an increased risk of neurologic events, without affecting the risk of 30-day mortality or renal failure. Although these patterns were identified, an overall paucity of evidence justifies further study.

Download Full-text