Impact Of Minimally Invasive Mitral Valve Repair On Inflammatory, Coagulation And Functional Laboratory Parameters
Sumi Westhofen, Yousef Alassar, Christian Detter, Ewaldas Girdauskas, Hermann Reichenspurner, Lenard Conradi.
University Heart Center Hamburg, Hamburg, Germany.
Objective: In most clinical studies minimally invasive mitral valve repair (MIC) is associated with improved clinical outcome but increased cardiopulmonary bypass (CPB), aortic cross-clamp (ACC) and procedure times. This study compares inflammatory, coagulation parameters, and cardiac and renal markers in patients undergoing MIC or conventional sternotomy mitral valve repair (ST).
Methods: A retrospective matched-pair analysis was performed in 74 patients (MIC: age 59.91±14.12 years, 29.7% female) undergoing isolated minimally-invasive 3D mitral valve repair from January to December 2016. A control group of patients with isolated mitral valve repair via sternotomy between 2013-2016 was retrieved from our database. Groups were matched regarding 7 preoperative patient characteristics (age, gender, BMI, comorbidities, mitral valve pathology, LV and RV function). Blood samples were collected pre- and postoperatively on day 1 to 5.
Results: There were no conversions to sternotomy in the MIC group. CPB and ACC times were longer in the MIC group (175.34±57.52/103.20±34.33min) compared to the ST group (129.66±39.73/79.79±28.66min; p< 0.001). ICU stay was 2±2.8 days in the MIC group vs. 3.2±3 days in the ST group (p< 0.01). In both groups, an increase of inflammatory and coagulation biomarkers was observed. Acute phase proteins fibrinogen (5.7±5.9 vs. 4.2±4g/l; p< 0.001) and C-reactive protein (100.66±50.95 vs. 67.73±65.48mg/l; p< 0.001) reached significantly higher levels postoperatively in the ST vs. MIC group. Thrombocytes reached lower levels in the ST group early postoperatively (132.2±143.8 vs. 150.6±143.4Mrd/l; p=0.01). Alanine and aspartate aminotransferase (ALT/AST: p=0.37/p=0.31) were not significantly different between both groups. Creatinine kinase reached significantly higher levels early postoperatively in the MIC group (767.08±2781.5 vs. 63.82±372.9U/l; p< 0.001), but showed no difference on day 5 day in comparison to the ST group. For Creatinine kinase mb and troponin I no significant differences between groups were seen. Creatinine was significantly increased early postoperatively in the ST compared to the MIC group (1.29±1.2 vs. 1.01±0.7mg/dl; p< 0.001).
Conclusion: In our study group we found reduced inflammatory reaction, coagulation and renal markers in the study compared to control group, supporting clinical evidence of reduced faster recovery and postoperative bleeding. Our data support further application of MIMVR.
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