Minithoracotomy Or Sternotomy Approach In Mitral Valve Surgery: A Propensity-matched Analysis
Marek Pojar, Mikita Karalko, Jan Vojacek.
University Hospital, Hradec Kralove, Czech Republic.
BACKGROUND: We aimed to investigate whether minimally invasive mitral valve surgery is superior to conventional surgery through full sternotomy. METHODS: A retrospective analysis of patients who underwent mitral valve surgery via minithoracotomy or full sternotomy between 2012 and 2018. A propensity score-matched analysis was generated to eliminate differences in relevant preoperative risk factors between the two groups. RESULTS: Using a matching technique, 158 patients in the minithoracotomy group and 225 patients in the sternotomy group were included in the analysis. The 30 day mortality was similar between the minithoracotomy and conventional surgery groups (1 and 3%, respectively; p = 0.25). No differences were seen in the incidence of stroke (p = 1.00), surgical site infections (p = 0.09), or myocardial infarction (p = 0.23), or in total hospital cost (p = 0.48). However, the minimally invasive approach was associated with fewer patients receiving transfusions (59% versus 76% in the conventional group; p = 0.001) or requiring reoperation for bleeding (3% versus 9%, respectively; p = 0.03). There were no significant differences in 5 year survival between the minithoracotomy and conventional surgery groups (93% versus 86%, respectively; p = 0.21) and freedom from mitral valve reoperation (95% versus 94%, respectively; p = 0.79). CONCLUSIONS: In patients undergoing mitral valve surgery, a minimally invasive approach is feasible, safe, and reproducible with excellent short-term outcomes; mid-term outcomes and efficacy were also seen to be comparable to conventional sternotomy.
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