Echocardiographic assessment of mitral durability in the late period following mitral valve repair: Minithoracotomy versus conventional sternotomy

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 147; no. 5; pp. 1547 - 1552
• Main Authors: Yoo, Jae Suk, MD, Kim, Joon Bum, MD, PhD, Jung, Sung-Ho, MD, PhD, Choo, Suk Jung, MD, PhD, Chung, Cheol Hyun, MD, PhD, Lee, Jae Won, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.05.2014
• Subjects: Adult; Aged; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - mortality; Cardiothoracic Surgery; Chi-Square Distribution; Echocardiography, Doppler; Female; Humans; Male; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; Mitral Valve - surgery; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; Predictive Value of Tests; Propensity Score; Proportional Hazards Models; Recurrence; Reoperation; Retrospective Studies; Risk Factors; Sternotomy - adverse effects; Sternotomy - mortality; Stroke - etiology; Thoracotomy - adverse effects; Thoracotomy - mortality; Time Factors; Treatment Outcome; AF; MR; mitral regurgitation; 28; minimally invasive cardiac surgery; IPTW; MICS; left atrial; MV; atrial fibrillation; inverse-probability-of-treatment weighting; LA; mitral valve; ICU; intensive care unit; 35.4
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2013.05.042

Objective To compare the long-term echocardiographic mitral valve (MV) durability after MV repair performed through a minithoracotomy versus conventional sternotomy. Methods A total of 299 patients who underwent MV repair for degenerative mitral regurgitation (MR) through minithoracotomy (n = 179) or sternotomy (n = 120), between April 2004 and January 2010, were evaluated. To adjust the differences in baseline characteristics between the 2 groups, weighted Cox proportional-hazards regression models and inverse-probability-of-treatment weighting were used. Results There were no 30-day deaths in both groups and no significant differences in early complication rates. Clinical follow-up was complete in 294 patients (98.3%), with a median follow-up of 55.4 months (interquartile range, 34.4-66.9 months), during which there were 10 late deaths, 2 strokes, and 3 reoperations for recurrent MR. After adjustment, the minithoracotomy group had similar risks for major adverse cardiac events (hazard ratio, 0.77; 95% confidence interval, 0.22-2.68; P  = .68). Echocardiographic evaluation in the late period (>6 months) was possible in 292 patients (97.7%), with a median follow-up of 29.4 months (interquartile range, 13.3-49.7 months), during which 21 patients (12 in the minithoracotomy group and 9 in the sternotomy group) experienced significant MR (>2+). Freedom from significant MR at 5 years was 86.1% ± 4.8% versus 85.3% ± 5.5% ( P  = .63). After adjustment, the minithoracotomy group had similar risks for significant MR (hazard ratio, 0.81; 95% confidence interval, 0.31-2.14; P  = .67). Conclusions A minithoracotomy approach for MV repair showed comparable clinical outcomes and efficacy to conventional sternotomy for MV repair.