Less Invasive Mitral Surgery Versus Conventional Sternotomy Stratified by Mitral Pathology

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Techniques
• Surgical Outcomes

Background:

• Mitral valve surgery is crucial for treating various mitral pathologies.
• Conventional sternotomy has been the standard approach for mitral valve surgery.
• Less invasive mitral surgery (LIMS) has emerged as an alternative approach.

Purpose of the Study:

• To compare national mitral repair rates and outcomes between LIMS and conventional sternotomy.
• To analyze outcomes across diverse mitral pathologies and repair techniques.
• To evaluate the impact of surgical approach on patient recovery and morbidity.

Main Methods:

• Analysis of The Society of Thoracic Surgeons Adult Cardiac Surgery Database (July 2014-December 2018).
• Inclusion of patients undergoing isolated primary mitral valve surgery.
• Application of propensity score models and inverse-probability weighting for adjusted outcome comparisons.

Main Results:

• Over 41,000 patients included; LIMS adoption increased annually.
• LIMS and higher procedural volumes were independently associated with increased mitral repair rates.
• LIMS demonstrated significantly reduced rates of stroke, atrial fibrillation, pacemaker need, renal failure, and shorter hospital stays, with no difference in mortality.

Conclusions:

• LIMS is associated with superior mitral repair rates and reduced morbidity compared to sternotomy.
• Surgeon volume may influence the choice of operative approach and patient outcomes.
• Further investigation into the surgeon volume-operator approach relationship is warranted.