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Background: Minimally invasive mitral valve surgery (MIS) has evolved to a routine procedure over the last years and is the approach of first choice in some specialized centers. Besides the obvious cosmetic benefit, the effects on postoperative outcome are still topic of discussion. Aim of this study was to compare the results after conventional sternotomy (CS) and MI mitral valve surgery using a propensity matched analysis.
Methods: Between January 2005 and August 2011 700 patients underwent isolated mitral valve surgery at our institution, 233 were treated using MIS and 467 using CS. Propensity scores were generated based on prior logistic regression with a 1:2 matching leading to 220 MIS and 429 CS patients.
Results: Patient risk profiles were comparable with a mean logistic EuroSCORE of 8.4±11% (MIS) versus 7.5±7.9% (CS) (p=0.220). MIS was advantageous in terms of lower 30-day mortality (3.6 vs. 6.1%; p=0.264) and lower stroke rate (3.6 vs. 5.4%; p=0.437) without reaching statistical significance. Mean cardiopulmonary bypass time was 145±43 min. (MIS) versus 109±36 min. (CS) and cross-clamp time was 89±37 min. (MIS) versus 77±27 min. (CS), p<0.001. The incidence of postoperative renal failure, pacemaker implants and re-thoracotomy was significantly lower in the MIS group (2.3 vs. 14.0%; p<0.001, 3.6 vs. 11.2%; p=0.001 and 5.5 vs. 12.1%; p=0.008). MIS patients received less blood transfusions (1.3±4.8 vs. 2.2±3.9; p=0.008) and had shorter median ICU stay (21.5 vs. 23.0 hours; p=0.043). Repair rate was significantly higher in MIS patients (90.5 vs. 78.6%; p<0.001).
Conclusion: Minimally invasive mitral valve surgery is as safe as the conventional sternotomy approach, and it is associated with less morbidity. Furthermore surgical options are not compromised, resulting in a valve repair rate of 90.5%. Thus minimally invasive mitral valve surgery will evolve as the procedure of choice.