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

Heart ◽  
2018 ◽  
Vol 105 (10) ◽  
pp. 783-789 ◽  
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.

scholarly journals Minimally invasive versus sternotomy mitral valve surgery when initiating a minimally invasive programme

2020 ◽  
Vol 58 (6) ◽  
pp. 1168-1174
Author(s):  
Mikael Kastengren ◽  
Peter Svenarud ◽  
Göran Källner ◽  
Anders Franco-Cereceda ◽  
Jan Liska ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Propensity Score ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Minimally Invasive Procedures ◽  
Invasive Procedures ◽  
Short Term ◽  
Invasive Approach

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 &lt; 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.

Myocardial Protection in Mitral Valve Surgery: Comparison Between Minimally Invasive Approach and Standard Sternotomy

2018 ◽  
Vol 32 (2) ◽  
pp. 656-663 ◽  
Author(s):  
Jean-Sébastien Lebon ◽  
Pierre Couture ◽  
Annik Fortier ◽  
Antoine G. Rochon ◽  
Christian Ayoub ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Myocardial Protection ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Minimally Invasive Approach ◽  
Invasive Approach

Obesity Should Not Deter a Surgeon from Selecting a Minimally Invasive Approach for Mitral Valve Surgery

2013 ◽  
Vol 8 (3) ◽  
pp. 225-229 ◽  
Author(s):  
Diana Reser ◽  
Simon Sündermann ◽  
Jürg Grünenfelder ◽  
Jacques Scherman ◽  
Burkhardt Seifert ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Surgery ◽  
Normal Weight ◽  
Valve Surgery ◽  
Cerebrovascular Event ◽  
Minimally Invasive Approach ◽  
Term Outcome ◽  
Invasive Approach ◽  
Postoperative Ventilation

Objective Obesity is highly prevalent in modern patient populations. Several studies have published conflicting outcomes after minimally invasive surgery with regard to morbidity and mortality. Some instances consider obesity as a relative contraindication for this approach because of inadequate exposure of the surgical field. Our aim was to investigate the outcomes of minimally invasive mitral valve surgery through a right lateral minithoracotomy in patients with a body mass index (BMI) of 30 kg/m2 or greater. Methods We conducted a retrospective database review between January 1, 2009, and December 31, 2011. Preoperative, intraoperative, postoperative, and follow-up data of 225 consecutive patients were collected. Results The patients were stratified according to their BMI: 108 had a normal weight with a BMI of lower than 25 kg/m2 (18–24), 90 were overweight with a BMI of 25 to 29 kg/m2, and 27 were obese with a BMI of 30 kg/m2 (30–41) or greater. Statistical analysis showed significantly longer ventilation times in the obese group, whereas all other variables were similar. Survival, major adverse cardiac and cerebrovascular event-free survival, valve competency, and freedom from reoperation were also comparable. Conclusions Our data suggest that obesity should not deter a surgeon from selecting a minimally invasive approach. Despite longer postoperative ventilation times, a BMI of 30 kg/m2 or greater does not influence short- and medium-term outcome. Obese patients may even benefit from this approach because it avoids the need for sternotomy and therefore reduces the risk for sternal wound infection.

scholarly journals Minimally invasive approach for aortic and mitral valve surgery

2016 ◽  
Vol 50 (6) ◽  
pp. 1204-1205 ◽  
Author(s):  
Antonio Lio ◽  
Antonio Miceli ◽  
Matteo Ferrarini ◽  
Mattia Glauber
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Minimally Invasive Approach ◽  
Invasive Approach

Obesity Should Not Deter a Surgeon from Selecting a Minimally Invasive Approach for Mitral Valve Surgery

2013 ◽  
Vol 8 (3) ◽  
pp. 225-229 ◽  
Author(s):  
Diana Reser ◽  
Simon Sündermann ◽  
Jürg Grünenfelder ◽  
Jacques Scherman ◽  
Burkhardt Seifert ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Minimally Invasive Approach ◽  
Invasive Approach

Mitral valve surgery: current status and future prospects of the minimally invasive approach

2021 ◽  
pp. 1-16
Author(s):  
Karel M. Van Praet ◽  
Jörg Kempfert ◽  
Stephan Jacobs ◽  
Christof Stamm ◽  
Serdar Akansel ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Current Status ◽  
Future Prospects ◽  
Minimally Invasive Approach ◽  
Invasive Approach

scholarly journals Minimally invasive or sternotomy approach in mitral valve surgery: a propensity-matched comparison

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Marek Pojar ◽  
Mikita Karalko ◽  
Martin Dergel ◽  
Jan Vojacek
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Median Sternotomy ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Total Hospital Cost ◽  
Minimally Invasive Approach ◽  
Conventional Surgery ◽  
Term Survival ◽  
Invasive Approach

Abstract Objectives Conventional mitral valve surgery through median sternotomy improves long-term survival with acceptable morbidity and mortality. However, less-invasive approaches to mitral valve surgery are now increasingly employed. Whether minimally invasive mitral valve surgery is superior to conventional surgery is uncertain. Methods A retrospective analysis of patients who underwent mitral valve surgery via minithoracotomy or median sternotomy between 2012 and 2018. A propensity score-matched analysis was generated to eliminate differences in relevant preoperative risk factors between the two groups. Results Data from 525 patients were evaluated, 189 underwent minithoracotomy and 336 underwent median sternotomy. The 30 day mortality was similar between the minithoracotomy and conventional surgery groups (1 and 3%, respectively; p = 0.25). No differences were seen in the incidence of stroke (p = 1.00), surgical site infections (p = 0.09), or myocardial infarction (p = 0.23), or in total hospital cost (p = 0.48). However, the minimally invasive approach was associated with fewer patients receiving transfusions (59% versus 76% in the conventional group; p = 0.001) or requiring reoperation for bleeding (3% versus 9%, respectively; p = 0.03). There were no significant differences in 5 year survival between the minithoracotomy and conventional surgery groups (93% versus 86%, respectively; p = 0.21) and freedom from mitral valve reoperation (95% versus 94%, respectively; p = 0.79). Conclusions In patients undergoing mitral valve surgery, a minimally invasive approach is feasible, safe, and reproducible with excellent short-term outcomes; mid-term outcomes and efficacy were also seen to be comparable to conventional sternotomy.

Minimally Invasive Mitral Valve Surgery for Mitral Valve Infective Endocarditis

2017 ◽  
Vol 66 (07) ◽  
pp. 525-529 ◽  
Author(s):  
Joerg Seeburger ◽  
Jens Garbade ◽  
Uta Schon ◽  
Martin Misfeld ◽  
Friedrich Mohr ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Annulus ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Mitral Leaflet ◽  
Minimally Invasive Approach ◽  
Invasive Approach

Background The feasibility of minimally invasive mitral valve (MV) surgery in infective endocarditis (IE) has not been reported in detail. We assessed the safety, efficacy, and durability of the minimally invasive approach through a right anterolateral minithoracotomy for surgical treatment of MV IE. Methods A review of the Leipzig Heart Center database revealed 92 eligible patients operated on between 2002 and 2013. All patients had undergone minimally invasive surgery for IE. The indication for surgery was isolated IE of the MV in all patients. Baseline and intraoperative data, as well as clinical outcomes and short-term follow-up were analyzed retrospectively. Results The patients' mean age was 60.9 ±  15.3 years, the logistic EuroSCORE II was 19.6 ± 19.1%, and 64.1% (59) were male. MV repair was feasible in 23.9% (22/92) of patients. Repair techniques included annuloplasty ring implantation, anterior mitral leaflet resection, posterior mitral leaflet resection, and implantation of neochordae. MV replacement was performed in 69 patients (75%), a mitral annulus patch in 1 patient, and concomitant tricuspid valve surgery for tricuspid regurgitation in 5 patients. Bacteriological analysis showed staphylococcus infection in 45.5%, streptococcus in 36.4%, enterococcus in 13.6%, and others in 4.5%. The 30-day-mortality rate was 9.8% (9 patients). The 1-year follow-up showed a 1-year survival rate of 77.7 ± 4.4% and freedom from reoperation within 1 year due to reendocarditis of 93.3 ± 2.1%. Conclusions The minimally invasive approach is suitable for the treatment of IE of the MV. It is a good technique in IE in selected patients.

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