Minimally invasive approach provides at least equivalent results for surgical correction of mitral regurgitation: A propensity-matched comparison

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 145; no. 3; pp. 748 - 756
• Main Authors: Goldstone, Andrew B., MD, Atluri, Pavan, MD, Szeto, Wilson Y., MD, Trubelja, Alen, BS, Howard, Jessica L., BS, MacArthur, John W., MD, Newcomb, Craig, MS, Donnelly, Joseph P., BS, Kobrin, Dale M., BA, Sheridan, Mary A., MPAS, PA-C, Powers, Christiana, MSN, CRNP, Gorman, Robert C., MD, Gorman, Joseph H., MD, Pochettino, Alberto, MD, Bavaria, Joseph E., MD, Acker, Michael A., MD, Hargrove, W. Clark, MD, Woo, Y. Joseph, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.03.2013
• Subjects: Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - mortality; Cardiothoracic Surgery; Echocardiography; Female; Hospital Mortality; Humans; Logistic Models; Male; Middle Aged; Minimally Invasive Surgical Procedures - methods; Minimally Invasive Surgical Procedures - mortality; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - surgery; Propensity Score; Statistics, Nonparametric; Sternotomy; Thoracotomy; Treatment Outcome; 35; 35.4.1; MR; mitral regurgitation; 28
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2012.09.093

Objective Minimally invasive approaches to mitral valve surgery are increasingly used, but the surgical approach must not compromise the clinical outcome for improved cosmesis. We examined the outcomes of mitral repair performed through right minithoracotomy or median sternotomy. Methods Between January 2002 and October 2011, 1011 isolated mitral valve repairs were performed in the University of Pennsylvania health system (455 sternotomies, 556 right minithoracotomies). To account for key differences in preoperative risk profiles, propensity scores identified 201 well-matched patient pairs with mitral regurgitation of any cause and 153 pairs with myxomatous disease. Results In-hospital mortality was similar between propensity-matched groups (0% vs 0% for the degenerative cohort; 0% vs 0.5%, P  = .5 for the overall cohort; in minimally invasive and sternotomy groups, respectively). Incidence of stroke, infection, myocardial infarction, exploration for postoperative hemorrhage, renal failure, and atrial fibrillation also were comparable. Transfusion was less frequent in the minimally invasive groups (11.8% vs 20.3%, P  = .04 for the degenerative cohort; 14.0% vs 22.9%, P  = .03 for the overall cohort), but time to extubation and discharge was similar. A 99% repair rate was achieved in patients with myxomatous disease, and a minimally invasive approach did not significantly increase the likelihood of a failed repair resulting in mitral valve replacement. Patients undergoing minimally invasive mitral repair were more likely to have no residual post-repair mitral regurgitation (97.4% vs 92.1%, P  = .04 for the degenerative cohort; 95.5% vs 89.6%, P  = .02 for the overall cohort). In the overall matched cohort, early readmission rates were higher in patients undergoing sternotomies (12.6% vs 4.4%, P  = .01). Over 9 years of follow-up, there was no significant difference in long-term survival between groups ( P  = .8). Conclusions In appropriate patients with isolated mitral valve disease of any cause, a right minithoracotomy approach may be used without compromising clinical outcome.