Long-term results after mitral valve surgery using minimally invasive versus sternotomy approach: a propensity matched comparison of a large single-center series.
BACKGROUND
Mitral valve (MV) surgery has traditionally been performed by conventional sternotomy (CS), but more recently minimally invasive surgery (MIS) has become another treatment option. The aim of this study is to compare short- and long-term results of MV surgery after CS and MIS.


METHODS
This study was a retrospective propensity-matched analysis of MV operations between January 2005 and December 2015.


RESULTS
Among 1357 patients, 496 underwent CS and 861 MIS. Matching resulted in 422 patients per group. The procedure time was longer with MIS than CS (192 vs. 185 min; p = 0.002) as was cardiopulmonary bypass time (133 vs. 101 min; p < 0.001) and X-clamp time (80 vs. 71 min; p < 0.001). 'Short-term' successful valve repair was higher with MIS (96.0% vs. 76.0%, p < 0.001). Length of hospital stay was shorter in MIS than CS patients (10 vs. 11 days; p = 0.001). There was no difference in the overall 30-day mortality rate. Cardiovascular death was lower after MIS (1.2%) compared with CS (3.8%; OR 0.30; 95%CI 0.11-0.84). The difference did not remain significant after adjustment for procedural differences (aOR 0.40; 95%CI 0.13-1.25). Pacemaker was required less often after MIS (3.3%) than CS (11.2%; aOR 0.31; 95%CI 0.16-0.61), and acute renal failure was less common (2.1% vs. 11.9%; aOR 0.22; 95%CI 0.10-0.48). There were no significant differences with respect to rates of stroke, myocardial infarction or repeat MV surgery. The 7-year survival rate was significantly better after MIS (88.5%) than CS (74.8%; aHR 0.44, 95%CI 0.31-0.64).


CONCLUSION
This study demonstrates that good results for MV surgery can be obtained with MIS, achieving a high MV repair rate, low peri-procedural morbidity and mortality, and improved long-term survival.
['Cetinkaya|Ayse|A|', 'Geier|Anna|A|', 'Bramlage|Karin|K|', 'Hein|Stefan|S|', 'Bramlage|Peter|P|0000-0002-4121-6866', 'Schönburg|Markus|M|', 'Choi|Yeong-Hoon|YH|', 'Richter|Manfred|M|']
D000368:Aged D005260:Female D005858:Germany D006349:Heart Valve Diseases D006801:Humans D007902:Length of Stay D008297:Male D008875:Middle Aged D019060:Minimally Invasive Surgical Procedures D008943:Mitral Valve D011183:Postoperative Complications D057216:Propensity Score D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D056346:Sternotomy D013997:Time Factors D016896:Treatment Outcome
Mitral valve Sternotomy Minimally invasive mitral valve surgery Mitral valve repair Outcomes