Long-term Outcomes Of Right Mini-thoracotomy Versus Hemi-sternotomy For Mitral Valve Repair
Edward Percy, Sameer Hirji, Farhang Yazdchi, Siobhan McGurk, Spencer Kiehm, Tsuyoshi Kaneko, Prem Shekar, Marc Pelletier.
Brigham and Women's Hospital, Boston, MA, USA.
Objective: Minimally-invasive approaches to mitral valve repair (MVP) have gained increasing attention. Right mini-thoracotomy (RT) and hemi-sternotomy (HS) have each been associated with improved patient outcomes compared with full sternotomy. However, these two minimally invasive approaches have not been directly compared to each other. The aim of this study was to compare long-term survival of mitral valve repair performed through RT versus HS approaches. Methods: We retrospectively identified all isolated MVP performed via right mini-thoracotomy or hemi-sternotomy between October 1998 and June 2018; 100 RT cases and 719 HS cases were selected. Baseline characteristics were compared. Outcomes of interest included postoperative complications, operative mortality and long-term survival. Total observation time was 9901 patient-years. Results: Mean age was 58±12 years in the RT group and 56±13 years in the HS group (p=0.2). Pre-operative characteristics were similar between groups although RT patients had a higher rate of congestive heart failure (40% vs. 19%, p≤0.001). The RT group had longer bypass (143min vs. 112min, p≤0.001) and cross-clamp times (99min vs. 78min, p≤0.001) compared with the HS group. Postoperatively, there were no differences in 30-day reoperation, stroke, atrial fibrillation, or length of stay between the two groups. There were no operative deaths in the RT group and 5 (0.7%) in the HS group (p=1.0). The overall median follow-up time was 12.2 years. Figure 1 shows a Kaplan-Meyer survival analysis where a contemporaneous group of full sternotomy (FS) primary isolated MVP cases was included for reference. At 1, 5, and 10 years, survival was 100% (95% CI 100 - 100%), 95% (95% CI 89 - 100%) and 92% (95% CI 84 - 100%) in the RT group and 98% (95% CI 97 - 99%), 94% (95% CI 92 - 96%) and 88% (95% CI 84 - 91%) in the HS group respectively (p<0.77). Survival in the FS group was 99% (95% CI 98 - 99%), 93% (95% CI 91 - 95%) and 78% (95% CI 73 - 83%). Conclusions: Minimally-invasive mitral valve repair is a safe operation with a 10-year survival of 88-92%. In patients who undergo mitral valve repair via either right thoracotomy or hemi-sternotomy, short and long-term outcomes are similar.
LEGEND: Kaplan-Meyer analysis of survival for patients undergoing mitral valve repair by right mini-thoracotomy versus hemi-sternotomy. Full sternotomy group is included for reference.
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