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Stand Alone Mitral Valve Repair: What are the Predictors for Minimally Invasive Approach?
Niv Ad, Sari D. Holmes, Graciela Pritchard, Anthony J. Rongione, Linda Halpin, Paul S. Massimiano.
Inova Heart and Vascular Institute, Falls Church, VA, USA.

OBJECTIVE: The surgical approach for isolated mitral valve surgery is dependent on the mitral valve pathology and the surgeon experience. The purpose of this study was to determine which clinical variables are associated with the decision to perform isolated mitral valve repair (MVR) using minimally invasive (MI) approach and the effect of these factors on perioperative outcomes.
METHODS: All consecutive patients with stand alone mitral valve repair from 2005-Nov 2012 were followed prospectively (N=373). Perioperative morbidity was captured according to STS definitions. Predictors for mid-sternotomy (MS) MVR were examined via logistic regression.
RESULTS: There were 212 patients with MI MVR and 161 with MS MVR surgery. The percent of patients with MI MVR has steadily increased during this time frame from 35% in 2005 to 76% in 2012 (through Nov). The significant predictors for MS MVR were older age (OR=1.20, 95%CI: 1.09-1.32, p<0.001), higher BMI (OR=1.06, 95%CI: 1.004-1.11, p=0.03) and CHF (OR=3.19, 95%CI: 1.80-5.65, p<0.001). For every 5 years increase in age, there was 20% greater odds for MS MVR; for each 1 point increase in BMI, there was 6% greater odds for MS MVR; and patients with CHF had 3 times greater odds for MS MVR. In CHF patients (16% vs 39%, p=0.04), older age patients (12% vs 47%, p<0.001) and higher BMI patients (3% vs 24%, p<0.001) the percentage of patients with any STS defined perioperative morbidity was significantly lower in those with MI MVR vs MS MVR, median length of stay was shorter for MI vs MS (2 vs 5 days, p=0.001; 3 vs 5 days, p<0.001; 2 vs 4 days, p<0.001, respectively) and there were no differences in operative mortality (0% vs 3.6%, p=1.00; 0% vs 4%, p=0.28; 0% vs 1%, p=1.00, respectively).
CONCLUSIONS: The data from our center indicate that age, BMI and CHF are the most important factors predicting which patients receive MI MVR or MS MVR. However, within patients with these factors, outcomes are similar or improved using the MI approach.


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