International Society For Minimally Invasive Cardiothoracic Surgery

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Partial Upper Sternotomy Versus Mini-thoracotomy For Isolated Mitral Valve Surgery: A Propensity-score Matched Analysis
Cenk U. Oezpeker, Fabian Barbieri, Daniel Hoefer, Christoph Krapf, Michael Grimm, Ludwig Mueller.
Medical University of Innsbruck, Innsbruck, Austria.

Background: Minimally invasive mitral valve surgery through anterolateral mini-thoracotomy (MT) has become the standard therapy for isolated mitral valve disease in experienced centers. Multiple valve disease or other anatomical and certain clinical conditions, however, make this access not suitable for some patients and conventional full sternotomy is the mostly preferred approach. For those patients partial upper sternotomy (PS) can be used as a less invasive access. Whereas MT has been widely investigated, there are not enough insights to the PS approach for mitral valve surgery (MVS) in more morbid patients. Therefore we compared the data of both accesses. Methods: This retrospective analysis includes data on 604 patients (MT n=486, PS n=118), who underwent either isolated or combined primary MVS via less invasive access at our department from May 2011 to September 2018. Out of the PS cohort, 24 patients were excluded due to additionally aortic valve or concomitant coronary bypass surgery leaving 94 patients who had been judged suitable for PS but also eligible for MT. To reduce the possibility of selection bias a 1:1 propensity-score matchmaking was performed which resulted in 71 pairs. Results: During a median follow-up time of 1585 days (29-2832; PS 562 [29-2778 days], MT 2454 [30-2832 days]) all cause mortality was 7.1% (n=5). In the propensitiy-score paired model, there was no statistically significance between the two cohorts in the 30-days and 1-year mortality. Furthermore the 3-years survival showed a superiority in the MT-cohort (PS n=4, MT n=0; p=0.011). However in the secondary endpoints the cardiopulmonary bypass times (MT 208 vs PS 165 min, p=<0.001), the x-clamp times (MT112 vs PS 103 min, p=0.045) and the length of hospital stay (MT 13 vs PS 9 days, p=0.014) showed a statistically superiority of the PS access. All other secondary endpoints showed no statistically significance. Conclusion: Despite higher morbidity of patients with PS, the mortality rates are minimally and comparable between both treatment cohorts. In addition shorter operative-times and similar perioperative outcomes in the PS-cohort may be a valid indication in high risk patients.

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