Concomitant Mitral Valve And Atrial Fibrillation Surgery: Can Minimally Invasive Benefits Be Translated Without Compromising Outcomes?
Mark R. Helmers, Jennifer Chung, Michael A. Acker, W Clark Hargrove, Pavan Atluri.
University of Pennsylvania, Philadelphia, PA, USA.
Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and carries an increased risk of thromboembolic events and heart failure. Of patients undergoing mitral valve (MV) surgery, 35-60% have some form of AF and the addition of surgical ablation to MV surgery improves freedom from AF. Concomitant MV and AF surgery is commonly performed via minimally invasive cardiothoracic surgery (MICS) techniques; however, data comparing MICS outcomes to traditional, gold standard, full sternotomy (FS) approaches is limited.
Methods: Our institutional Society of Thoracic Surgeons database was queried for patients who underwent concomitant MV and AF surgery from 2002 to 2015. Patients undergoing additional valve, coronary, or aortic procedures were excluded. Baseline characteristics and perioperative outcomes were compared between surgical approaches.
Results: Overall, 538 concomitant MV and AF surgeries met inclusion criteria during the study period. Of these, 303 (56%) were performed via FS and 235 (44%) were MICS. FS patients were more likely to be female (48% vs 39%, P = 0.045), have NYHA class III symptoms or higher (44% vs 32%, P = 0.004), and have an urgent or emergent operative status (18% vs 5%, P < 0.001). Total operative (210 vs 234 min, P < 0.0001), cardiopulmonary bypass (117 vs 143 min, P < 0.0001), and cross clamp times (91 vs 105 min, P < 0.001) were longer for the MICS group, although these patients were also more likely to receive MV repair than replacement (68% vs 89%, P < 0.001). Postoperatively, MICS was associated with lower blood product utilization (44% vs 28% P < 0.001) and shorter initial ventilator times (10 vs 7.4 hrs, P < 0.0001), as well as shorter initial ICU (44 vs 26 hrs, P = 0.001) and hospital (8 vs 7 days, P = 0.002) length of stays. Mortality at discharge was similar between groups (3.0% vs 1.7%, P = 0.407).
Conclusions: Concomitant MV and AF surgery via MICS is a safe alternative to FS. While operative times may be longer, lower blood product utilization and faster recovery may be advantages of MICS approaches.
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