Minimally invasive mitral valve surgery performed within a multidisciplinary heart team model achieved a 94.6% repair success rate with a peri-operative mortality of 0.36%, and paravertebral catheter use reduced hospital length of stay by approximately 17%.
Observational (n=278)
No
Does a multidisciplinary heart team approach with specific intra-operative and peri-operative initiatives improve outcomes in adult patients undergoing minimally invasive mitral valve surgery?
A multidisciplinary heart team approach incorporating regional anesthesia, percutaneous cannulation, and automated knot-tying devices in minimally invasive mitral valve surgery is associated with reduced hospital length of stay, shorter operative times, and low complication rates.
Effect estimate: Successful repair rate 94.6%; 30-day mortality 0.36% (1/278)
Background: The advantage of employing multidisciplinary heart teams (MDHT) for the selection process of minimally invasive (MIS) mitral valve repair (MVr) and mitral valve replacement (MVR) has been previously substantiated. Here, we outline the contributions each member of the MDHT at our institution made during the intra-operative and peri-operative periods and describe their impacts on short-term outcomes. Patients and Methods: This is a single-center retrospective review of all 278 adult patients who underwent MIS MVR or MVr by a single surgeon at our institution between 2006 and 2023. The repair’s efficacy was assessed intraoperatively and at 1 year post-operation. The surgical technique involved a mini-thoracotomy and valve repair or replacement. Outcomes included post-operative mortality, complications, operative time, repair success rate, hospital length of stay (LOS), and post-operative ejection fraction. There was no control group, as all patients undergoing MIS MVR/MVr were treated within an MDHT model. Results: Delivery of regional anesthesia via paravertebral catheter (PVC) was associated with a statistically significant shorter hospital LOS (6.52 vs. 7.81 days, p = 0.028). Enhanced Recovery After Surgery (ERAS) implementation by nurses was associated with a potentially clinically important, although not statistically significant, reduction in LOS (6.7 vs. 10.1 days, p = 0.168). Introduction of the COR-KNOT® DEVICE for securing annuloplasty sutures was associated with a statistically significant reduction in operative time (288 vs. 326 min, p < 0.001). Percutaneous cannulation, proctored by interventional cardiology in 2019, was associated with a decrease in lymphocele rate from 6.2% before 2019 to 0% after 2019. Conclusions: Initiatives implemented by our MDHT were associated with reduced post-operative LOS, shorter operative times, and lower incidence of post-operative complications.
Mourad et al. (Thu,) conducted a observational in Adults undergoing minimally invasive mitral valve repair or replacement with diverse mitral valve pathology including those with reduced LVEF and prior cardiac surgery, excluding patients with atrial fibrillation, severe pulmonary hypertension, severe lung disease precluding single lung ventilation, very low LVEF (<30%), severe peripheral vascular disease, or an intrathoracic anterior–posterior dimension <10 cm (n=278). Multidisciplinary heart team approach delivering minimally invasive mitral valve repair or replacement was evaluated on Post-operative mortality and successful mitral valve repair rate at 1 year, with hospital length of stay and operative time as key peri-operative outcomes (Successful repair rate 94.6%; 30-day mortality 0.36% (1/278)). Minimally invasive mitral valve surgery performed within a multidisciplinary heart team model achieved a 94.6% repair success rate with a peri-operative mortality of 0.36%, and paravertebral catheter use reduced hospital length of stay by approximately 17%.