Abstract
Purpose
The aim of this study was to compare the cases of minimally invasive mitral valve surgery (MICS-mitral) performed using right mini-thoracotomy (RT) with those performed using median sternotomy (MS).
Methods
Between 2008 and 2012, 6137 patients underwent isolated mitral valve repair at 210 institutions and were registered in the Japan Adult Cardiovascular Surgery Database. We compared 756 who underwent MICS-mitral via RT to 5381 MS patients and performed a one-to-one matched analysis based on the estimated propensity score.
Results
The in-hospital mortality was similar between both groups (RT vs. MS: 0.5 vs. 1.1 %). Although the incidence of postoperative stroke, renal failure, and prolonged ventilation was similar, the number of patients with mediastinitis was greater in the MS group (RT vs. MS: 0 vs. 0.7 %, p < 0.01). Reexploration for bleeding was more frequent in the RT group (RT vs. MS: 2.9 vs. 1.4 %, p < 0.01). Mortality and morbidity occurred at a higher rate in low-volume institutions. The propensity analysis showed that the operation-related times were significantly longer in the RT group, while the length of hospital stay was shorter. In a propensity analysis of patients <60 years of age, there was no in-hospital mortality.
Conclusions
MICS-mitral via RT was successful without compromising the clinical outcomes. Although the operation time and postoperative bleeding should be improved, an RT approach is safe in appropriately selected patients, especially those <60 years of age or treated in a high-volume center.
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References
Mohr FW, Falk V, Diegeler A, Walther T, van Son JA, Autschbach R. Minimally invasive port-access mitral valve surgery. J Thorac Cardiovasc Surg. 1998;115:567–74.
Cohn LH, Adams DH, Couper GS, Bichell DP, Rosborough DM, Sears SP, et al. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg. 1997;226:421–6.
Casselman FP, Van Slycke S, Wellens F, De Geest R, Degrieck I, Van Praet F, et al. Mitral valve surgery can now routinely be performed endoscopically. Circulation. 2003;108(Suppl 1):II48–54.
Woo YJ, Seeburger J, Mohr FW. Minimally invasive valve surgery. Semin Thorac Cardiovasc Surg. 2007;19:289–98.
Grossi EA, LaPietra A, Ribakove GH, Delianides J, Esposito R, Culliford AT, et al. Minimally invasive versus sternotomy approaches for mitral reconstruction: comparison of intermediate-term results. J Thorac Cardiovasc Surg. 2001;121:708–13.
Suri RM, Thalji NM. Minimally invasive heart valve surgery: how and why in 2012. Curr Cardiol Rep. 2012;14:171–9.
Schmitto JD, Mokashi SA, Cohn LH. Minimally-invasive valve surgery. J Am Coll Cardiol. 2010;56:455–62.
Holzhey DM, Seeburger J, Misfeld M, Borger MA, Mohr FW. Learning minimally invasive mitral valve surgery: a cumulative sum sequential probability analysis of 3895 operations from a single high-volume center. Circulation. 2013;128:483–91.
Galloway AC, Schwartz CF, Ribakove GH, Crooke GA, Gogoladze G, Ursomanno P, et al. A decade of minimally invasive mitral repair: long-term outcomes. Ann Thorac Surg. 2009;88:1180–4.
Beckmann A, Funkat AK, Lewandowski J, Frie M, Schiller W, Hekmat K, et al. Cardiac surgery in Germany during 2012: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg. 2014;62:5–17.
Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V, et al. Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med. 2005;352:875–83.
Jiang Z, Mei J, Ding F, Bao C, Zhu J, Tang M, et al. The early and mid-term results of mitral valve repair for mitral regurgitation in children. Surg Today. 2014;44:2086–91.
Murashita T, Okada Y, Fujiwara H, Kanemitsu H, Fukunaga N, Konishi Y, et al. Mechanism of and risk factors for reoperation after mitral valve repair for degenerative mitral regurgitation. Circ J. 2013;77:2050–5.
Manabe S, Kasegawa H, Fukui T, Tabata M, Shinozaki T, Shimokawa T, et al. Do semi-rigid prosthetic rings affect left ventricular function after mitral valve repair? Circ J. 2013;77:2038–42.
Amano J, Kuwano H, Yokomise H. Thoracic and cardiovascular surgery in Japan during 2011: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2013;61:578–607.
Goldstone AB, Atluri P, Szeto WY, Trubelja A, Howard JL, MacArthur JW Jr, et al. Minimally invasive approach provides at least equivalent results for surgical correction of mitral regurgitation: a propensity-matched comparison. J Thorac Cardiovasc Surg. 2013;145:748–56.
Iribarne A, Russo MJ, Easterwood R, Hong KN, Yang J, Cheema FH, et al. Minimally invasive versus sternotomy approach for mitral valve surgery: a propensity analysis. Ann Thorac Surg. 2010;90:1471–7.
Svensson LG, Atik FA, Cosgrove DM, Blackstone EH, Rajeswaran J, Krishnaswamy G, et al. Minimally invasive versus conventional mitral valve surgery: a propensity-matched comparison. J Thorac Cardiovasc Surg. 2010;139:926–32.
Motomura N, Miyata H, Tsukihara H, Okada M. Takamoto S; Japan Cardiovascular Surgery Database Organization. First report on 30-day and operative mortality in risk model of isolated coronary artery bypass grafting in Japan. Ann Thorac Surg. 2008;86:1866–72.
Modi P, Hassan A, Chitwood WR Jr. Minimally invasive mitral valve surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2008;34:943–52.
Richardson L, Richardson M, Hunter S. Is a port-access mitral valve repair superior to the sternotomy approach in accelerating postoperative recovery? Interact Cardiovasc Thorac Surg. 2008;7:678–83.
Cheng DC, Martin J, Lal A, Diegeler A, Folliguet TA, Nifong LW, et al. Minimally invasive versus conventional open mitral valve surgery: a meta-analysis and systematic review. Innovations (Phila). 2011;6:84–103.
Miyata H, Motomura N, Ueda Y, Matsuda H, Takamoto S. Effect of procedural volume on outcome of coronary artery bypass graft surgery in Japan: implication toward public reporting and minimal volume standards. J Thorac Cardiovasc Surg. 2008;135:1306–12.
McClure RS, Athanasopoulos LV, McGurk S, Davidson MJ, Couper GS, Cohn LH. One thousand minimally invasive mitral valve operations: early outcomes, late outcomes, and echocardiographic follow-up. J Thorac Cardiovasc Surg. 2013;145:1199–206.
Gammie JS, Zhao Y, Peterson ED, O’Brien SM, Rankin JS, Griffith BP. Less-invasive mitral valve operations: trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg. 2010;90:1401–8.
Dogan S, Aybek T, Risteski PS, Detho F, Rapp A, Wimmer-Greinecker G, Moritz A. Minimally invasive port access versus conventional mitral valve surgery: prospective randomized study. Ann Thorac Surg. 2005;79:492–8.
Woo YJ, Nacke EA. Robotic minimally invasive mitral valve reconstruction yields less blood product transfusion and shorter length of stay. Surgery. 2006;140:263–7.
Holzhey DM, Shi W, Borger MA, Seeburger J, Garbade J, Pfannmüller B, et al. Minimally invasive versus sternotomy approach for mitral valve surgery in patients greater than 70 years old: a propensity-matched comparison. Ann Thorac Surg. 2011;91:401–5.
Novick RJ, Fox SA, Stitt LW, Kiaii BB, Swinamer SA, Rayman R, et al. Assessing the learning curve in off-pump coronary artery surgery via CUSUM failure analysis. Ann Thorac Surg. 2002;73:S358–62.
Falk V, Cheng DC, Martin J, Diegeler A, Folliguet TA, Nifong LW, et al. Minimally invasive versus open mitral valve surgery: a consensus statement of the international society of minimally invasive coronary surgery (ISMICS) 2010. Innovations (Phila). 2011;6:66–76.
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Nishi, H., Miyata, H., Motomura, N. et al. Propensity-matched analysis of minimally invasive mitral valve repair using a nationwide surgical database. Surg Today 45, 1144–1152 (2015). https://doi.org/10.1007/s00595-015-1210-7
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DOI: https://doi.org/10.1007/s00595-015-1210-7