International Society For Minimally Invasive Cardiothoracic Surgery

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Minimally Invasive Mitral Valve Surgery Is Associated With A Lower Incidence Of Acute Kidney Injury
Amine Mazine1, Gabrièla Esperanza Arias-Vézina1, Ismail Bouhout1, Sina Maftoon1, Louis-Mathieu Stevens2, Philippe Demers1, Michel Pellerin1, Denis Bouchard1.
1Montreal Heart Institute, Montreal, QC, Canada, 2Centre Hospitalier Universitaire de Montréal, Montreal, QC, Canada.

BACKGROUND - Acute kidney injury (AKI) following cardiac surgery is a common complication that is associated with substantial mortality and morbidity. The purpose of this study was to compare the incidence of AKI following mitral valve surgery between patients undergoing a right anterolateral minithoracotomy versus a median sternotomy.
METHODS - Between September 2010 and December 2014, 584 consecutive patients underwent isolated mitral valve surgery. Of these, 283 (48%) received a right anterolateral minithoracotomy and 301 (52%) received a median sternotomy. All patients were prospectively entered in our institution’s computerized database. Serum creatinine levels were measured prior to surgery and daily thereafter until hospital discharge. Acute kidney injury was defined by the consensus RIFLE (Risk, Injury, Failure, Loss of function, End-stage renal disease) criteria. The impact of surgical technique on AKI and other perioperative outcomes was assessed using propensity score-adjusted multivariable regression analysis.
RESULTS - Mean age was 62.4±12.4 years and 300 patients (51%) were male. A total of 383 patients (66%) underwent mitral valve repair, whereas 201 (34%) underwent mitral valve replacement. Ninety-six patients (16%) had undergone previous cardiac surgery. Thirty-six patients (13%) in the minithoracotomy group and 69 patients (23%) in the sternotomy group suffered from postoperative AKI. Propensity score-adjusted outcome analysis showed that minithoracotomy was associated with lower rates of AKI (OR 0.61 [0.37-1.00]; p=0.05). Similarly, after adjusting for the propensity score, rates of perioperative red blood cell transfusion were lower in the minithoracotomy group (OR 0.56 [0.37-0.83]; p=0.004). Operative mortality occurred in 2 patients (1%) in the minithoracotomy group versus 13 (4%) in the sternotomy group. This difference did not reach statistical significance after propensity score adjustment (OR 0.33 [0.07-1.70]; p=0.19). Mean intensive care unit length of stay was shorter in the minithoracotomy group (2.3 days vs 3.7 days; p=0.001).
CONCLUSIONS - In patients undergoing mitral valve surgery, a minimally invasive approach via a right anterolateral minithoracotomy is associated with a lower incidence of AKI, lower rates of postoperative transfusion requirements and shorter intensive-care unit length of stay. Further studies are needed to assess whether these perioperative benefits translate into improved long-term outcomes.

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