090VIDEO-ASSISTED RIGHT MINI-THORACOTOMY VERSUS FULL STERNOTOMY FOR ISOLATED MITRAL VALVE REPAIR: A PROPENSITY-MATCHED COMPARISON

• Published in: Interactive cardiovascular and thoracic surgery Vol. 19; no. suppl_1; p. S27
• Main Authors: Günther, T., Kehl, V., Voss, B., Lange, R.
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.10.2014
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivu276.90

Objectives: Mitral valve repair (MVR) through a right mini-thoracotomy (RT) is technically more demanding than through a median sternotomy (MS) and has been cited for a higher rate of reoperation, increased bleeding, thromboembolic events, poor visualisation and longer operative times. Specific parameters of patients are usually highly different. Therefore, a propensity-matching study was performed to reduce selection bias and to make patient outcomes comparable. Methods: Retrospective analysis was carried out of 745 patients who underwent isolated MVR between 2000 and 2010, 501 patients in group RT and 244 in group MS. Propensity matching identified 97 matched patient-pairs for comparison of functional outcome, survival, incidence of reoperation and quality of life after MVR. Results: Propensity-matched patients in group RT experienced a longer CPB (120 ± 28 vs 99 ± 30 min, P < 0.001) and cross-clamp time (86 ± 23.5 vs 74 ± 25 min, P < 0.001). Thirty-day mortality was similar in group RT (0%) and MS (1%), P = 0.13. There were no significant differences in other outcomes such as red blood cell transfusions, ventilation time and the hospital stay. Five-year survival in group RT vs MS (93.5 ± 3.7% vs 87.4 ± 3.6%; P = 0.556) and freedom from mitral-valve-related reoperation (93.3 ± 2.9% vs 88.1 ± 5.8%; P = 0.157) were not different. Functional outcome and the quality of life parameters, such as the physical (47.7 vs 46.4) and psychological (50.2 vs 49.5) SF36 component scores were similar. Conclusion: Mitral valve surgery through a right mini-thoracotomy is a safe procedure associated with a very low operative mortality comparable to the standard sternotomy approach. As well as improved cosmetics, minimally invasive MV surgery provides equally durable results as the standard sternotomy approach.