Propensity Score Adjusted Comparison of Totally Thoracoscopic vs Video Assisted Minimally Invasive Mitral Valve Surgery
Radoslaw Smoczynski, Mariusz Kowalewski, Jakub Staromlynski, Anna Witkowska, Dominik Drobinski, Wojciech Sarnowski, Piotr Suwalski
Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
BACKGROUND: We sought to compare the totally thoracoscopic periareolar (TTP)- and video-assisted (VA)- approaches for minimally invasive mitral valve surgery (MIMVS).
METHODS: Between 2011 and 2018, 400 consecutive patients underwent minimally invasive heart surgery due to mitral and mitral-tricuspid valve disease. The first 215 patients were operated via right-sided VA minithoracotomy, while the following 185 patients were operated via the TTP approach. Clinical characteristics and outcomes between the groups were analyzed and adjusted by means of propensity score matching.
RESULTS: Of 400 patients, 62.3% underwent isolated MV repair, 11.8% isolated MV replacement and 25.3% mitral+tricuspid valve repair. There was no difference in in-hospital mortality between the TTP group (2.1%) and the VA group (3.1%): Hazard Ratio (HR): 0.68 (95% Confidence Intervals [CIs]):0.08-5.91; P=0.724). Stroke occurred in 2.3% patients in VA- and none in the TTP subgroups (P=0.31). The average aortic cross-clamp time was not significantly different between the groups, with 103±39 min and 97±46 min in the TTP and VA groups (P=0.719) respectively. Cardiopulmonary bypass time was no different as well 166±53 vs. 166±70 min (P=0.422). No conversion to either full sternotomy or TTP to VA was required. Within investigated follow-up, there was no difference in terms of reoperation estimated rates (98.5% in VA and 97.8% in TTP; P=0.439) and no difference in overall estimated 5-years survival between the TTP- (94.3%) and the VA- (96.2%) MIMVS- undergoing patients: HR: 0.71 (95%CIs): 0.08-6.39); P=0.763. After propensity matching adjusted HR was 0.74 (95%CIs: 0.06-6.56); P=0.740.
CONCLUSIONS: The study proved an equal safety and feasibility of the totally thoracoscopic periareolar and video-assisted minithoracotomy access in minimally invasive mitral valve surgery.