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Outcomes of Minimally Invasive Valve Surgery versus Median Sternotomy in Patients with Chronic Kidney Disease
Background: Minimally invasive surgery typically requires longer cardiopulmonary bypass times, which may lead to post-operative kidney injury. Therefore, we studied the effect of a minimally invasive approach compared with median sternotomy in patients with chronic kidney disease (CKD) undergoing isolated valve surgery.
Methods: We retrospectively reviewed 1017 consecutive patients to identify patients with CKD stages 2-5 who underwent isolated valve surgery. In-hospital mortality, STS-defined composite complication rates, as well as intensive care unit, and total hospital length of stay were compared by CKD stage and by type of surgery.
Results: CKD was present in 465/1017 (45.7%). Of the 465 patients with CKD, 291 (62%) underwent minimally invasive surgery and 174 (38%) had a median sternotomy. There were no significant differences in the patient baseline characteristics, except for age, which was 71.2 ± 11 years in the minimally invasive group, and 68.7 ± 12.5 in the median sternotomy group (p = 0.008). There was no difference in STS risk score for morbidity and mortality between groups (p=0.56). The minimally invasive approach was associated with fewer STS-defined composite complications (40.2% versus 68.4%, p=<0.001). There was no difference in the need for dialysis (1% versus 1.1%, p=0.49), nor mortality (1.7% versus 3.4%, p=0.38) nor acute kidney injury (8% versus 11.9%, p=0.17) for the minimally invasive and median sternotomy group, respectively. Intensive care unit and total hospital lengths of stay were 48 hours (IQR 33-74) versus 51.3 hours (IQR 42-96), p<0.001 and 8 days (IQR 6-9) versus 10 days (IQR 8-15, p<0.001 for the minimally invasive and the median sternotomy group, respectively.
Logistic regression analyses showed the minimally invasive approach to be independently associated with fewer composite complications (OR: 0.18 P<0.0001; 95% CI=0.11-0.31).
Conclusions: In patients with CKD, minimally invasive valve surgery is associated with reduced post-operative complications, shorter intensive care unit and total hospital lengths of stay, and despite longer bypass times did not increase the incidence of acute kidney injury.