Minimally Invasive Surgery Versus Sternotomy Approach In Mitral Valve Redo
Erik Cura Stura, Claudia Calia, Cristina Barbero, Giovanni Marchetto, Marco Pocar, Massimo Boffini, Mauro Rinaldi.
Cittą della Salute e della Scienza di Torino - Molinette, Torino, Italy.
BACKGROUND: Redo mitral valve surgery performed through median sternotomy is associated with significant mortality and morbidity. Minimally invasive surgery (MIS) through right mini-thoracotomy allows the surgeon to avoid re-entry injuries and related complications.
METHODS: From January 2006 to January 2019, 423 redo mitral valve procedures were performed in our department: 134 (31.7%) with sternotomy approach and 289 (68.3%) MIS through right mini-thoracotomy.
RESULTS: The two groups (sternotomy vs MIS) differ in logistic EuroSCORE (25.4±19.7 vs 19.0±16.4, p=0.004), number of previous surgeries (1.2±0.6 vs 1.4±0.8, p=0.005), urgency (20.9 % and 6.6 %, p 0.001) and PAPS (56.2 ± 15.9 vs 50.1 ± 16.0, p 0.003). The cannulation chosen was considerably different in the two cohorts and tailored on patient characteristics. In MIS the preferred cannulation setting was the peripheral with endoclamp (78.2%); peripheral with transthoracic clamp was used in 7.3% and with endodirect clamp in 5.9%. In sternotomy group central cannulation was preferred (88.1%) while peripheral was used only in 10.5%. Fibrillating heart technique was use only in MIS group (8.0%). Aortic cross clamp time was significantly longer in sternotomy (98.6±31.3 vs 89.5±28.5, p< 0.05), while there was no difference in cardiopulmonary bypass time (137.8 ± 47.0 vs 139.2 ± 47.4, p 0.87). Mean intubation time (14 vs 12 h, p < 0.05) and ICU stay (48 vs 24 h, p 0.03) were lower in MIS group. Early postoperative complications were comparable in the two groups except for higher rate of blood transfusion (p<0.0001), tracheostomy (p=0.026) and new onset of atrial fibrillation (p<0.0001) in sternotomy cohort. No significant difference was reported in 30-day mortality (8.2% vs 5.9%, p 0.24). Higher freedom from reoperation (at 8 years 95% vs 83 %, p 0.01) and survival rate (at 5 years 80% vs 89%; at 12 years 60% vs 75% p 0.04) was observed in the MIS cohort.
CONCLUSIONS: MIS allows excellent results in high risk patients as redo mitral valve surgery
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