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International Society For Minimally Invasive Cardiothoracic Surgery

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Minimally-invasive Mitral Valve Surgery Reduces Hospital Resource Utilization Compared To Sternotomy: A Propensity Matched Study
Ryan J. Vela1, Mary E. Huerter1, Lily Campbell2, Neelan Doolabh1, Jessica Pruszynski1.
1UT Southwestern Medical Center, Dallas, TX, USA, 2Boston University, Boston, MA, USA.

Background: We aim to analyze hospital resource utilization and discharge disposition differences between two different surgical approaches to mitral valve surgery in a propensity-matched model. Methods: Propensity score matched pairs were selected after identification of all mitral valve patients during the study period. Median and interquartile ranges described continuous variables; categorical variables were described using frequencies and percentages. Kruskal-Wallis test was used for continuous and ordinal categorical variable comparisons; chi square and Fisher’s exact test was used to compare nominal categorical variables. Patients with endocarditis and those whom received other simultaneous cardiac operations were excluded. A composite of post-operative complications was created consisting of surgical site infection, reoperation, stroke, pneumonia, venous thromboembolism, pneumothorax, rhythm disturbance requiring intervention, 30-day mortality, and readmission.
Results: 185 mitral valve patients were identified,, 64 underwent FS and 121 MI. After propensity score matching, 64 matched pairs were identified. The post-matching pairs are summarized in Table 1. Bivariate analysis of the matched pairs yielded significantly reduced operative, bypass, and cross-clamp times in the MI group (FS: 299 minutes [264-361], MI: 174 minutes [154.2-205.2], p &lt 0.001; FS: 151.5 minutes [123-181.2], MI: 111.5 minutes [94.8-124.2], p &lt 0.001; FS: 105 minutes [90.8-132.5], MI: 79.5 minutes [70.8-92.2], p &lt 0.001). Overall intraoperative and postoperative blood product transfusions were significantly reduced in the MI approach compared to FS (p &lt 0.001 for each type of blood product). A composite score for post-operative complications was created and was significantly less in the MI group (FS: 28 [44%], MI: 11 [17%], p &lt 0.001). Total ventilator hours was reduced in the MI group along with ICU hours (FS: 9.8 hours [4.7-23], MI: 1 hour [0-3.9], p &lt 0.001; FS: 91 hours [64.4-139.2], MI: 29 hours [24.9-50.1], p &lt 0.001). Overall length of stay was reduced in the MI approach (FS: 8 days [7-11], MI: 4 days [3-5], p &lt 0.001). Lastly, discharge home versus nursing home or rehab facility discharge was significantly improved in the MI group (p = 0.034).
Conclusions: MI approach to mitral surgery reduces overall hospital resource utilization and improves discharge disposition compared to FS.

Post-Matching Variables
VariableSternotomy (n=64)Minimally-Invasive (n=64)
Age61.1 years (53.1-66.6)65.5 years (47.5-71.2)
COPD18 (28%)13 (20%)
EF57 (46-62)59 (50-60)
Moderate-Severe Mitral Regurgitation45 (70%)59 (92%)
Pulmonary Hypertension44 (69%)38 (59%)

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