Key result
Minimally invasive mitral valve repair was associated with significantly lower blood loss and shorter hospital stay compared to median sternotomy, with comparable 12-month echocardiographic outcomes.
Why the study?
There is a paucity of data comparing minimally invasive mitral valve repair to the conventional approach in patients with degenerative disease.
Does minimally invasive mitral valve repair improve operative and clinical outcomes compared to conventional median sternotomy in patients with degenerative mitral valve disease?
Cohort (n=215)
No
Does minimally invasive mitral valve repair improve operative and clinical outcomes compared to conventional median sternotomy in patients with degenerative mitral valve disease?
Absolute Event Rate: 370% vs 550%
p-value: p=<0.001
Minimally invasive mitral valve repair is a viable alternative to conventional sternotomy for degenerative mitral valve disease, offering reduced blood loss and shorter ICU stays with comparable safety and echocardiographic outcomes.
May support selective use of minimally invasive mitral repair; leaves open need for randomized confirmation.
Background There is a paucity of data comparing the minimally invasive mitral valve repair (MiMVr) to the conventional approach in patients with degenerative disease. Our objective was to compare the outcomes of MiMVr to the traditional mitral valve repair through median sternotomy in patients with degenerative mitral valve disease. We conducted a retrospective study on 215 patients classified into two groups. Group 1 (n = 80) included those who had mitral valve repair through a right anterolateral video-assisted mini-thoracotomy, and group 2 (n = 135) was approached through a conventional median sternotomy. We compared the preoperative, operative, and postoperative data between groups. Both groups had echocardiographic follow-ups after 6 and 12 months. Results There was no difference in gender distribution between both groups, and patients who had median sternotomy were significantly older (median 37 (Q1-Q3, 29-44) vs. 54 (48-60) years; P < 0.001). Cardiopulmonary bypass (134.5 (130-138.5) vs. 99 (97-104) min; P < 0.001) and ischemic times (99 (95-105.5) vs. 78 (75-81) min; P < 0.001) were significantly shorter in patients who had median sternotomy. Patients with MiMVr had significantly lower blood loss (370 (315-390) vs. 550 (490-600) ml; P < 0.001) and ICU stay (5 (4.5-6) vs. 7 (7-8) days; P < 0.001). There was no difference between both groups regarding re-exploration for bleeding, postoperative stroke, wound infection, renal failure, and mortality. As regards postoperative echocardiography follow-up at 6 and 12 months after the operation, there were no significant changes in the mean mitral valve gradient within each group; however, the mean gradient was lower in the MiMVr group (3 (3-3.5) vs. 4 (3-5) mmHg; P < 0.001). There was no significant difference between both groups regarding mitral regurgitation severity during 6 and 12 months follow-up. Conclusion Minimally invasive mitral valve repair in patients with degenerative pathology could be an alternative to conventional mitral valve surgery with comparable short-term and long-term outcomes.
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Fouly et al. (2021) conducted a cohort in Degenerative mitral valve disease (n=215). Minimally invasive mitral valve repair vs. Conventional median sternotomy was evaluated on Blood loss (ml) (p=<0.001). Minimally invasive mitral valve repair was associated with significantly lower blood loss and shorter hospital stay compared to median sternotomy, with comparable 12-month echocardiographic outcomes.
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