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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
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Minimally invasive mitral valve surgery after previous sternotomy: A propensity-matched analysis
Mohanad Hamandi1, John J Squiers1, Allison T Lanfear1
1Department of Cardiovascular Research, Baylor Scott & White-The Heart Hospital, Plano, Texas, USA.
Journal of Cardiac Surgery
|June 6, 2021
Summary
Minimally invasive (MIS) mitral valve (MV) surgery is a safe and feasible alternative for patients with prior sternotomy (ST). This approach demonstrated comparable survival rates and reduced transfusion needs compared to traditional sternotomy for reoperative MV surgery.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Procedures
Background:
- Reoperative mitral valve (MV) surgery incidence is rising after prior open-heart procedures.
- Sternotomy (ST) is the conventional approach, but optimal methods lack consensus.
- Investigating minimally invasive surgery (MIS) feasibility for reoperative MV procedures.
Purpose of the Study:
- To evaluate the safety and feasibility of MIS reoperative MV surgery.
- Compare MIS versus ST approaches in patients with previous sternotomy.
- Assess operative mortality, survival rates, complications, and length of stay.
Main Methods:
- Retrospective review of 305 patients undergoing reoperative MV surgery (2007-2018).
- Comparison of sternotomy (ST) and minimally invasive surgery (MIS) groups using propensity-matched analysis.
- Coprimary endpoints: operative mortality and 1-year survival; secondary endpoints: complications and length of stay.
Main Results:
- After propensity matching, 30-day and 1-year mortality were similar between MIS and ST groups (3.4% vs. 8%, p=0.19; 15.9% vs. 16.5%, p=0.9, respectively).
- Minimally invasive surgery (MIS) patients required significantly fewer red blood cell and fresh frozen plasma transfusions (p<0.01).
- MIS patients were older and more likely to have had prior coronary artery bypass grafting.
Conclusions:
- Minimally invasive (MIS) mitral valve surgery is a safe alternative for patients with prior sternotomy (ST).
- The study supports MIS as a viable option for reoperative mitral valve procedures.
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