Minithoracotomy vs Conventional Sternotomy for Mitral Valve Repair
Key result
Minithoracotomy shows no benefit over median sternotomy for physical function recovery at 12 weeks.
- MD 0.68
- 95% CI -1.89 to 3.26
- n=330
Why the study?
The safety and effectiveness of mitral valve repair via thoracoscopically-guided minithoracotomy compared with median sternotomy in patients with degenerative mitral valve regurgitation was uncertain.
Does thoracoscopically-guided minithoracotomy improve physical functioning at 12 weeks compared to median sternotomy in adults undergoing mitral valve repair for degenerative mitral regurgitation?
Population
330 adults with degenerative mitral regurgitation undergoing mitral valve repair surgery
Comparison
Minithoracotomy vs sternotomy mitral valve repair
Design
Pragmatic, multicenter, superiority, randomized clinical trial
Follow-up
Up to 1 year
Authors
Discussion
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Member takes
Implication
Minithoracotomy is not superior for physical function recovery at 12 weeks; extends RCT evidence of equivalent repair quality and 1-year safety.
Key Points
- To determine whether thoracoscopically-guided minithoracotomy provides superior recovery of physical functioning and comparable safety to median sternotomy for degenerative mitral valve repair.
- Pragmatic, multicenter, superiority randomized clinical trial across 10 tertiary care institutions in the UK (ISRCTN13930454).
- Randomized 330 adults (mean age 67 years; 30% female) 1:1 via concealed allocation to undergo either minithoracotomy (n = 166) or conventional median sternotomy (n = 164) mitral valve repair performed by expert surgeons.
- Evaluated the primary outcome of change from baseline in the SF-36 physical functioning T score at 12 weeks post-surgery alongside 1-year safety and echocardiographic endpoints.
- Mean between-group difference in the SF-36 physical function T score change at 12 weeks was 0.68 (95% CI, -1.89 to 3.26), demonstrating no superiority for minithoracotomy.
- Surgical valve repair rates reached approximately 96% in both arms, and 1-year echocardiography confirmed none or mild mitral regurgitation in 92% of participants in both groups.
- Composite safety endpoint events (death, repeat valve surgery, or heart failure hospitalization) at 1 year occurred in 5.4% (9 of 166) of minithoracotomy patients versus 6.1% (10 of 163) of sternotomy patients.
Study Design
Type
RCT (n=330)
Blinding
Single-blind
Randomization
1:1
Multicenter
Yes
Structured PICO
Does thoracoscopically-guided minithoracotomy improve physical functioning at 12 weeks compared to median sternotomy in adults undergoing mitral valve repair for degenerative mitral regurgitation?
P
Population
330 adults with degenerative mitral regurgitation undergoing mitral valve repair surgery, followed for up to 1 year.
I
Intervention
Thoracoscopically-guided minithoracotomy mitral valve repair performed by an expert surgeon
C
Comparator
Median sternotomy mitral valve repair performed by an expert surgeon
O
Outcome
Physical functioning and associated return to usual activities measured by change from baseline in the 36-Item Short Form Health Survey (SF-36) version 2 physical functioning scale 12 weeks after the index surgerypatient reported
Main Result
Mean Difference: 0.68 (95% CI -1.89–3.26)
Minithoracotomy is not superior to conventional median sternotomy for early recovery of physical function at 12 weeks, though both approaches offer excellent and comparable 1-year safety and valve repair rates.
Cite This Study
Akowuah et al. (2023) conducted an RCT in Degenerative mitral valve regurgitation (n=330). Thoracoscopically-guided minithoracotomy vs. Median sternotomy was evaluated on Change from baseline in the SF-36 version 2 physical functioning scale at 12 weeks (MD 0.68, 95% CI -1.89 to 3.26). Minithoracotomy was not superior to median sternotomy in recovery of physical function at 12 weeks (mean difference 0.68; 95% CI -1.89 to 3.26).