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Minimally Invasive Valve Surgery for Patients With Infective Endocarditis: A Comparative Study
Connor Raikar1, Stanley Wolfe2, Luigi F Lagazzi2
1Northwestern University Feinberg School of Medicine, Chicago, Illinois.
The Annals of Thoracic Surgery
|February 13, 2025
Summary
Minimally invasive cardiac surgery (MICS) for endocarditis valve surgery is safe and effective, showing similar repair rates and risk-adjusted outcomes compared to conventional sternotomy. This approach offers comparable results for patients needing complex valve procedures.
Area of Science:
- Cardiac Surgery
- Thoracic Surgery
- Infectious Diseases
Background:
- Endocarditis often necessitates valve surgery, with conventional sternotomy remaining the recommended approach despite advances in minimally invasive cardiac surgery (MICS).
- This study investigates the safety and efficacy of MICS for endocarditis valve surgery.
Purpose of the Study:
- To compare outcomes of minimally invasive cardiac surgery (MICS) versus conventional sternotomy for patients with endocarditis.
- To assess the impact of MICS on valve repair rates and major morbidity or mortality.
Main Methods:
- Utilized The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (July 2016-March 2024).
- Stratified patients into conventional sternotomy and MICS groups (hemisternotomy, right thoracotomy, robotic-assisted).
- Employed logistic regression for risk-adjusted analysis of STS major morbidity/mortality.
Main Results:
- MICS demonstrated higher mitral valve repair rates (76.3% vs 48%) but lower tricuspid valve repair rates (22.5% vs 44.1%).
- Unadjusted analysis showed MICS associated with longer cross-clamp times but lower major morbidity/mortality.
- Risk-adjusted analysis revealed age, lung disease, creatinine, and repair vs. replacement as independent predictors of morbidity/mortality, not MICS approach.
Conclusions:
- Minimally invasive cardiac surgery (MICS) is a safe and effective option for endocarditis valve surgery.
- MICS offers comparable risk-adjusted outcomes and improved mitral valve repair rates versus conventional sternotomy.
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