Key result
Minimally invasive mitral valve surgery via right mini-thoracotomy had low 30-day mortality (1.5%), though concomitant tricuspid valve surgery significantly increased the risk of adverse events (OR 4.44).
Why the study?
The study aimed to evaluate the risk analysis and learning curve of a minimally invasive mitral valve surgery program performed through a right mini-thoracotomy at a single institution.
Cohort (n=266)
No
Odds Ratio: 4.44 (95% CI 1.61–11.8)
p-value: p=0.003
Minimally invasive mitral valve surgery via right mini-thoracotomy is safe with low mortality, though concomitant tricuspid surgery increases risk and the learning curve requires 65 to 100 procedures to optimize outcomes.
Low mortality supports mini-thoracotomy mitral surgery feasibility; concomitant tricuspid repair was associated with higher risk, leaving optimal selection open.
Background This study aimed to report on the risk analysis and learning curve analysis of a minimally invasive mitral valve surgery program performed through a right mini-thoracotomy at a single institution. Methods From January 2013 through December 2019, we retrospectively reviewed 266 patients who underwent minimally invasive mitral valve surgery. Multiple logistic regression analysis was used for the adverse event outcome. Distribution over time of perioperative complications, defined as clinical endpoints in the Valve Academic Research Consortium-2 (VARC-2) consensus document, as well as CUSUM charts for assessment of cardiopulmonary bypass and aortic cross-clamping duration over time, has been performed for learning curve assessment. Results Overall incidences of postoperative stroke (1.1%), myocardial infarction (1.1%), and thirty-day mortality (1.5%) were low. The mitral valve reconstruction rate in our series counted 95%. Multivariable analysis revealed that concomitant tricuspid valve surgery (OR:4.44;95%CI:1.61–11.80;p = 0.003) was significantly associated with adverse event outcomes. Despite a trend towards adverse event outcomes in patients with preexisting active mitral valve endocarditis (OR:2.69;95%CI:0.81–7.87;p = 0.082), mitral valve pathology did not significantly impact postoperative morbidity and mortality. Distribution over time of perioperative complications, defined as clinical endpoints in the VARC-2 consensus document, showed a trend towards an improved complication rate after the initial 65 to 100 procedures. Conclusions Mitral valve surgery via right-sided mini-thoracotomy can be implemented safely with low perioperative morbidity and mortality rates. Careful patient selection regarding isolated mitral valve surgery in the presence of degenerative mitral valve disease may represent a significant safety issue during the learning curve. Trial Registration The cantonal ethics commission of Zurich approved the study (registration ID 2020 − 00752, date of approval 24 April 2020).
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Papadopoulos et al. (2023) conducted a cohort in Mitral valve pathology (n=266). Minimally invasive mitral valve surgery via right mini-thoracotomy was evaluated on Adverse event outcome (composite of failed repair, reexploration, low cardiac output, stroke, MI, new dialysis, or ICU > 3 days) associated with concomitant tricuspid valve surgery (OR 4.44, 95% CI 1.61-11.80, p=0.003). Minimally invasive mitral valve surgery via right mini-thoracotomy had low 30-day mortality (1.5%), though concomitant tricuspid valve surgery significantly increased the risk of adverse events (OR 4.44).
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