Endoscopic Versus Direct-vision Mitral Repair: A Propensity Score Analysis
Rafik Margaryan, Sara Michelotti, Giacomo Bianchi, Marco Solinas.
Ospedale Del Cuore Fondazione 'G. Monasterio', Massa, Italy.
BACKGROUND: Endoscopic (ENDS) and direct-vision (DIRV) mitral repair are well established, but differences in patient selection and outcomes are not well documented .
METHODS: A retrospective analysis was performed on 525 ENDS and 597 DIRV mitral procedures at one institution from July 2015 to September 2022. ENDS patients had 4 cm nonrib spreading incisions with endoscopic guide, while DIRV patients had 6-8 cm rib spreading incisions without any thoracoscopic assistance. Propensity score analysis matched patients for differences in baseline characteristics.
RESULTS: Unmatched ENDS patients were younger (63.9 ± 10.3 vs. 68.4 ± 10.7, p < 0.01), had a higher percentage of males (72% vs. 48%, p < 0.01) and had less NYHA Class 3-4 symptoms (13% vs. 28%, p < 0.01), less atrial fibrillation (12% vs. 23%, p = .02) and less tricuspid regurgitation (13% vs. 33%, p = 0.01). Pump time (143.7 ± 28.9 vs. 137.0 ± 42.0, p < 0.01) and clamp time (91.5 ± 21.0 vs. 89.1 ± 27.0, p < 0.01) were longer for ENDS patients. Postoperative stay, however, was shorter in ENDS (7.0 ± 3.8 vs. 8.0 ± 6.5, p = 0.009). Repair rate was higher in ENDS patients (87 % vs. 58 %, p < 0.01). Overall mortality were comparable between groups (0.38 % vs 0.8 % , p = 0.2).
Matched Propensity score analysis of matched patients showed that pump time (143.7 ± 28.9 vs. 136.6 ± 42.3, p = 0.008) and clamp time (91.5 ± 21.0 vs. 89.4 ± 27.6, p = 0.238) were longer for ENDS patients. Postoperative stay remained shorter in ENDS (7.0 ± 3.8 vs. 8.0 ± 6.5, p < 0.01). Repair rate was higher in ENDS patients even after matching (83 % vs. 66 %, p < 0.01).
However, postoperative morbidity, and 7-year survival (96 ± 1% vs. 95 ± 3%, p = .7) were not different. For matched patients with degenerative valve disease, 7-year incidence of mitral re-operation were comparable in both groups, severe mitral regurgitation (MR) (6 ± 4% vs. 1 ± 1%), or ≥2 + MR (12 ± 5% vs. 12 ± 4%), were not significantly different between ENDS versus DIRV approaches.
CONCLUSIONS: In this study for 7 years of follow-up ENDS versus DIRV approach to mitral repair had higher repair rate, slightly longer pump and clamp times, but resulted less postoperative stay with higher repair rate. Peri-operative morbidity, 7-year survival and repair durability were otherwise similar. 
Back to 2023 ePosters