Minimally invasive versus sternotomy approach for mitral valve surgery in patients greater than 70 years old: a propensity-matched comparison.

Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
The Annals of thoracic surgery (Impact Factor: 3.45). 02/2011; 91(2):401-5. DOI: 10.1016/j.athoracsur.2010.08.006
Source: PubMed

ABSTRACT The goal of this study was to compare the outcome after mitral valve surgery through either standard sternotomy or right lateral minithoracotomy in elderly patients with higher perioperative risk.
All 1,027 elderly patients (>70 years) who received isolated mitral valve surgery (± tricuspid valve repair) between August 1999 and July 2009 were analyzed for outcome differences due to surgical approach using propensity score matching. The etiology of mitral valve disease was degenerative (83%), endocarditis (6%), rheumatic (10%), and acute ischemic (<1%). Isolated stenosis was rare (3%); most patients had mitral valve regurgitation (72%) or combined mitral valve disease (25%).
The minimally invasive approach led to longer duration of surgery (186 ± 61 vs 169 ± 59 minutes, p = 0.01), cardiopulmonary bypass time (142 ± 54 vs 102 ± 45 minutes, p = 0.0001), and cross-clamp time (74 ± 44 vs 64 ± 28 minutes, p = 0.015). There were no differences between the matched groups in 30-day mortality (7.7% vs 6.3%, p = 0.82), combined major adverse cardiac and cerebrovascular events (11.2% vs 12.6%, p = 0.86), or other postoperative outcome. Only the number of postoperative arrhythmias and pacemaker implants was higher in the sternotomy group (65.7% vs 50.3%, p = 0.023 and 18.9% vs 10.5%, p = 0.059). Long-term survival was 66% ± 5.6% vs 56 ± 5.5% at 5 years and 35% ± 12% vs 40% ± 7.9% at 8 years, and did not show significant differences.
Minimally invasive mitral valve surgery through a right lateral minithoracotomy is at least as good and safe as the standard sternotomy approach in elderly patients.

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    ABSTRACT: Objective To update the current evidence of mitral valve surgery through a lateral minithoracotomy versus median sternotomy. Methods We performed a comprehensive literature research regarding studies comparing mitral valve surgery through a right lateral minithoracotomy (MIVS) and median sternotomy in MEDLINE, EMBASE, Cochrane Central, CTSnet and Google Scholar for the most recent literature up to April 2013. From the studies found in the literature we performed a systematic review and meta-analysis. Results More than 20’000 patients out of 45 studies were included in this study. Stroke rate and all-cause mortality up to 30 days was similar in both groups. The length of stay in the ICU, respirator dependence and hospital stay were significantly shorter in the MIVS-group. Furthermore, blood drainage volume and blood transfusions were decreased in the MIVS-group. On the contrary, cardiopulmonary bypass time, cross clamp time and procedure length were longer in the MIVS-group. Postoperative new atrial fibrillation was less in the MIVS-group. Aortic dissections occurred more in the MIVS-group. The rate of reexplorations and postoperative renal failure was similar in both groups. Conclusions MIVS and conventional mitral valve surgery show a similar perioperative outcome. Mitral valve surgery via a right lateral minithoracotomy seems to be favorable in regards of resource related outcome.
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