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Full sternotomy has more significant impact than the cardiopulmonary bypass time in patients of Mitral Valve Surgery: A propensity score matched study
Chen Xin, Qiu Zhibing, Xu Ming, Wang Liming, Jiang Yinshuo, Huang Fuhuang.
Nanjing First Hospital, Nanjing, China.
Objective: We sought to compare the minimally invasive mitral valve surgery through a right anterolateral minithoracotomy fairly with conventional full sternotomy approaches by using propensity score matching methods. The study assess if the incision methods has more significant impact for patients than the cardiopulmonary bypass time.
Methods: From January 2011 to October 2013, a total of 320 isolated mitral valve operations were performed at our institution. Data were retrospectively collected on all patients, and a logistic regression model was created to predict selection to minimally invasive approach versus conventional sternotomy approach. Propensity scores were then generated based on the regression model and matched pairs created using 1:1 nearest neighbor matching. There were 50 matched pairs in the analysis for a total sample size of 320(sternotomy, n=50; minimally invasive, n=50). Clinical outcomes included bypass and cross clamp time, morbidity, and mortality.
Results: The minimally invasive approach led to longer cardiopulmonary bypass time (128 ± 56 vs 86 ± 21 minutes, p <.01), and cross-clamp time (78 ± 24 vs 55 ± 12 minutes, p<.01). There were no differences between the matched groups in 30-day mortality (2% vs 2%, p >0.05). However, mediastinal drainage was lower at 6 and 24 hours after a minimally invasive approach (100 ml [CL, 50-175 ml] and 240 ml [CL,150-320 ml]) than after conventional sternotomy (425 ml [CL, 320-650ml] and 680 ml [CL, 560-850 ml]) at these times (p <.001). Transfusion was less frequent after minimally invasive surgery than after conventional surgery (26% vs 58%, p = .01). Volume of RBCs transfused was reduced by nearly two units for minimally invasive versus sternotomy group. Early after operation, pain scores were lower (p < .001) after minimally invasive surgery. There were 1 sternal wound infections (4.0%) in the sternotomy group compared with none in minimally invasive group.
Conclusions: Despite minimally invasive mitral valve surgery required a longer cardiopulmonary bypass time and cross-clamp time, less postoperative chest drainage, fewer need for perioperative blood transfusion and absence of sternal wound infection are the main advantages over conventional surgery. The full sternotomy has more significant impact than the cardiopulmonary bypass time.
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