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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Minimally invasive versus conventional mitral valve surgery: a propensity-matched comparison.
Lars G Svensson1, Fernando A Atik, Delos M Cosgrove
1Center for Aortic Surgery and Marfan and Connective Tissue Disorder Clinic, the Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, 9500 Euclid Ave/Mail Stop J4-1, Cleveland, OH 44195, USA. svenssl@ccf.org
The Journal of Thoracic and Cardiovascular Surgery
|December 1, 2009
Summary
Minimally invasive mitral valve surgery offers cosmetic, reduced blood use, and pain benefits compared to conventional sternotomy. Outcomes like mortality and stroke were similar between approaches in this study.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Minimally invasive mitral valve surgery is gaining traction for cosmetic benefits.
- Limited comparative outcome data exists for minimally invasive versus conventional sternotomy approaches.
Purpose of the Study:
- To compare outcomes of minimally invasive mitral valve surgery with conventional sternotomy.
- Utilize propensity-matching to account for patient characteristic differences.
Main Methods:
- Retrospective analysis of 2124 minimally invasive and 1047 conventional sternotomy cases (1995-2004).
- Propensity score matching created 590 well-matched pairs.
- Compared in-hospital mortality, stroke, renal failure, myocardial infarction, and infection rates.
Main Results:
- Similar in-hospital mortality (0.17% vs 0.85%) and major morbidity between groups.
- Minimally invasive surgery showed significantly less mediastinal drainage (250 vs 350 mL) and fewer transfusions (30% vs 37%).
- Higher rates of operating room extubation (18% vs 5.7%) and improved early postoperative respiratory function and pain scores with minimally invasive techniques.
Conclusions:
- Minimally invasive mitral valve surgery provides advantages in cosmesis, blood product use, respiratory function, and pain.
- No apparent increase in mortality or morbidity was observed compared to conventional sternotomy.
- Further research should compare robotic and percutaneous procedures to these minimally invasive outcomes.
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