Comparison Between Conventional And Minimally Invasive Mitral Valve Surgery. A Brazilian Single-center Experience.
Carlos M. A. Brandão, Elinthon T. Veronese, Pablo M. A. Pomerantzeff, Márcio S. M. Lima, Flávio Tarasoutchi, Fábio B. Jatene.
Heart Institute - University of São Paulo Medical School, São Paulo, Brazil.
BACKGROUND: Our objective is to describe and compare the short-term outcomes between conventional and minimally invasive mitral valve surgery in a Brazilian center. METHODS: We performed a retrospective analysis of 67 patients referred to our institution to mitral valve surgery between July 2014 and July 2017. Inclusion criteria were isolated mitral valve disease, normal left ventricular ejection fraction and absence of pulmonary hypertension. Exclusion criteria were reoperations, peripheral vascular disease, ischemic mitral disease, obesity and chest abnormalities. Forty patients were eligible to video-assisted minimally invasive mitral surgery. The other 27 patients were submitted to conventional mitral surgery. About 44% of patients had rheumatic disease and the mean EuroSCORE 2 was 0.87%. The minimally invasive approach was performed by right anterior mini-thoracotomy (6.0cm) in the fourth intercostal space with venous and arterial femoral cannulation and the conventional approach by median sternotomy with central cannulation. The procedures were performed by the same surgical team in a standard approach with mild hypothermia and cold blood cardioplegia. The following variables were analyzed: operative mortality, cardiopulmonary bypass time, aortic cross-clamp time and postoperative complications (neurologic dysfunction, renal dysfunction, atrial fibrillation, hemotransfusion, wound infection, reoperation for bleeding and vascular complications). Statistical analysis was performed with Fischer Test or T-Test. RESULTS: The conventional group presented one operative death (3.7%) and no mortality was registered in the minimally invasive group (p=0.03). Both cardiopulmonary bypass (105min vs 72min, p=0.09) and ischemic time (70min vs 52min, p=0.12) were longer in the minimally invasive approach, without statistical relevance. Conventional group presented more wound infection (p=0.04) and reoperation for bleeding (0.03). Minimally invasive group presented more vascular complications (p=0.04). Neurologic and renal dysfunctions were not observed in neither group. New onset of atrial fibrillation and hemotransfusion were similar in both groups. CONCLUSION: This study indicates the safety of minimally invasive mitral surgery in low risk patients, presenting less wound infection and reoperation for bleeding, although presenting more vascular complications.
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