Back to 2016 Annual Meeting Cardiac Track

OBJECTIVE: To compare perioperative outcomes in patients with previous sternotomy undergoing mitral valve surgery via redo sternotomy, right thoracotomy, or lateral endoscopic approach using robotics (LEAR).
METHODS: From 2006-2013, 291 patients with a history of previous sternotomy surgery underwent reoperative isolated mitral +/- tricuspid valve surgery at a single US academic institution. Propensity scoring was used to compare in-hospital and 30-day outcomes between the LEAR technique and sternotomy or thoracotomy approaches.
RESULTS: Of 291 patients, 151 (51.9%) had a repeat sternotomy, 71(24.4%) had a right thoracotomy approach, and 69 (23.7%) had a LEAR approach. Composite outcome of death or stroke was 5.8% (n=4) with the LEAR technique, compared to 6.6% (p=0.9) and 11.3% (p=0.3) in the sternotomy and thoracotomy groups, respectively. Cardiopulmonary bypass (CPB) and aortic occlusion times in the LEAR group (139.8±53.3 and 87.8±37.0 min, respectively) were similar to the Sternotomy group (131.1±49.3 and 97.2±39.9 min, respectively), but were significantly shorter compared to the thoracotomy group (163.6±54.7 min, p=0.01 and 129.1±60.7 min, p<0.001, respectively). Following propensity adjustment, the LEAR technique was associated with a shorter hospital and ICU length of stay (p <0.01) compared to sternotomy, and fewer perioperative blood transfusions compared to both sternotomy and thoracotomy (37.7% vs 83.4% and 77.5%, p<0.01, respectively). Mitral valve repair rates were significantly higher with the LEAR technique (66.7%) compared to sternotomy (11.3%, p<0.001) and thoracotomy (5.6%, p<0.001).
CONCLUSIONS: Mitral valve repair or replacement after a previous sternotomy can be performed effectively using the LEAR technique with low morbidity and mortality, and is associated with fewer transfusion requirements and a higher repair rate compared to sternotomy and thoracotomy techniques.