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Minimally invasive surgery versus sternotomy in native mitral valve endocarditis: a matched comparison

Markus Kofler1, Karel M Van Praet1,2, Julie Schambach1

  • 1Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|August 18, 2021
PubMed
Abstract

Insights

Minimally invasive surgery (MIS) offers significant clinical benefits over median sternotomy (MS) for native mitral valve infective endocarditis. MIS is associated with shorter operative times and reduced need for blood transfusions.

Area of Science:

  • Cardiovascular Surgery
  • Infective Endocarditis
  • Minimally Invasive Techniques

Background:

  • Native mitral valve infective endocarditis poses significant clinical challenges.
  • Surgical intervention is often necessary for effective treatment.
  • Traditional median sternotomy (MS) carries potential risks and complications.

Purpose of the Study:

  • To compare the clinical outcomes of minimally invasive surgery (MIS) versus median sternotomy (MS) in patients with native mitral valve infective endocarditis.
  • To evaluate the efficacy and safety of MIS in this patient population.
  • To identify potential benefits of MIS over traditional sternotomy.

Main Methods:

  • A retrospective study included 154 patients with native mitral valve infective endocarditis (2009-2019).
  • One-to-one nearest neighbour propensity score matching was used, considering endocarditis severity (De Feo score) and 19 other variables, resulting in 39 matched pairs.
  • Operative and postoperative outcomes were compared between the MIS and MS groups.

Main Results:

  • Minimally invasive surgery (MIS) was associated with significantly shorter overall operative times compared to median sternotomy (MS) (P=0.005).
  • MIS required fewer red blood cell (P=0.001) and fresh frozen plasma (P=0.002) transfusions.
  • Patients undergoing MIS experienced shorter ventilation times (P=0.024) and a lower rate of reintubation (P=0.021).

Conclusions:

  • Minimally invasive surgery (MIS) provides significant clinical benefits for selected patients with native mitral valve infective endocarditis.
  • MIS may lead to improved postoperative recovery and reduced resource utilization compared to MS.
  • Further research may explore long-term outcomes and expand patient selection criteria for MIS.
Keywords:
Clinical outcomeInfective endocarditisMinimally invasive surgeryMitral valveSternotomy

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