The impact of minimally invasive mitral valve surgery on early postoperative organ dysfunction

The use of a minimally invasive approach in mitral valve surgery is increasing; however, its impact on early organ dysfunction and hemodynamic support remains debated. This study compared postoperative organ dysfunction, assessed by the Sequential Organ Failure Assessment score and the maximum vasoactive-inotropic score at 24 hours, between the minimally invasive approach in mitral valve surgery and sternotomy.

A retrospective analysis was performed of all consecutive patients undergoing mitral valve surgery at a single center. Patients were stratified according to surgical approach (minimally invasive approach in mitral valve surgery vs sternotomy). Primary outcomes were Sequential Organ Failure Assessment and maximum vasoactive-inotropic score at 24 hours. Group comparisons were performed using nonparametric tests, and multivariable regression models were adjusted for demographics and clinical covariates. A propensity score-matched sensitivity analysis was also performed.

A total of 710 patients were included, 275 undergoing the minimally invasive approach in mitral valve surgery and 435 undergoing sternotomy. Median Sequential Organ Failure Assessment at 24 hours was lower after the minimally invasive approach in mitral valve surgery (4 [interquartile range, 2-6] vs 5 [interquartile range, 3-9], P < .001), and fewer patients undergoing the minimally invasive approach in mitral valve surgery had Sequential Organ Failure Assessment of 5 or more (43.6% vs 58.6%). On multivariable analysis, the minimally invasive approach in mitral valve surgery was independently associated with lower odds of elevated Sequential Organ Failure Assessment (odds ratio, 0.24, 95% CI, 0.15-0.37, P < .001). Maximum vasoactive-inotropic score at 24 hours was also lower after the minimally invasive approach in mitral valve surgery, with fewer patients presenting a maximum vasoactive-inotropic score at 24 hours of 13 or more (44.7% vs 56.1%); the minimally invasive approach in mitral valve surgery remained associated with lower odds of an elevated maximum vasoactive-inotropic score at 24 hours (odds ratio, 0.34, 95% CI, 0.22-0.51, P < .001). In the propensity score-matched cohort, the minimally invasive approach in mitral valve surgery remained associated with lower Sequential Organ Failure Assessment at 24 hours (mean difference, -2.64; 95% CI, -3.81 to -1.47; P < .0001), lower maximum vasoactive-inotropic score at 24 hours (mean difference, -23.82; 95% CI, -39.44 to -8.2; P = .003), lower odds of Sequential Organ Failure Assessment of 5 or more (odds ratio, 0.35; 95% CI, 0.2-0.63; P < .001), and lower odds of maximum vasoactive-inotropic score at 24 hours of 13 or more (odds ratio, 0.56; 95% CI, 0.33-0.97; P = .039). Differences were also observed across individual Sequential Organ Failure Assessment components, with the greatest separation in the cardiovascular, renal, and neurologic domains.

In this large single-center cohort, the minimally invasive approach in mitral valve surgery was associated with lower early postoperative organ dysfunction and reduced vasoactive-inotropic support compared with sternotomy. These findings were consistent after multivariable adjustment and propensity score matching and support a more favorable early postoperative physiologic profile with a minimally invasive approach in mitral valve surgery.