Key result
Minimally invasive mitral valve surgery shows ~78% six-year survival in high-risk patients.
Observational (n=88)
No
Minimally invasive mitral valve surgery in high-risk patients is associated with acceptable early mortality and long-term survival, though standard risk scores show suboptimal discrimination.
Supports feasibility of MIMVS in truly high-risk patients; leaves open need for prospective validation and improved risk models.
OBJECTIVE: This study aimed to assess in a retrospective series of truly high-risk patients who underwent minimally invasive mitral valve surgery: (1) postoperative and long-term results and (2) logistic EuroSCORE and EuroSCORE II discrimination power. METHODS: Between 2003 and 2013, we reviewed in our institution patients who underwent minimally invasive mitral valve surgery with or without tricuspid valve repair via right minithoracotomy with logistic EuroSCORE of 20 or higher. RESULTS: Among a total number of 1604, 88 patients were identified. Median logistic and EuroSCORE II was 27.29 (interquartile range, 15.3) and 12.7% (11.3%), respectively. Mean (SD) age was 71.9 (8.4) years; 42 were female (47.7%); 60 patients (68.1%) underwent previous sternotomy. Mitral valve was replaced in 59 (67%) and repaired in 29 (32.9%) patients; tricuspid valve repair was performed in 23 patients (26.1%). Median cardiopulmonary bypass and cross-clamp times were 157 minutes (interquartile range, 131-187 minutes) and 83 minutes (81-116 minutes), respectively; conversion to sternotomy and reopening for bleeding was necessary in 4 (4.5%) and 3 (3.4%) patients; permanent and transient neurological injuries were reported in 6 (6.8%) and 3 (3.4%) patients; acute kidney injury was reported in 13 patients (14.7%); 15 patients (17%) had pulmonary complications. Ten patients died while in the hospital (11.2%). Survival at 6 years was 78% (95% confidence interval, 69-88). CONCLUSIONS: In this series of truly high-risk patients, minimally invasive mitral surgery was associated with acceptable early mortality and morbidity as well as long-term outcomes; both logistic and EuroSCORE II showed suboptimal discrimination power.
No takes yet. Share an insight, caveat, or question.
Moscarelli et al. (2015) conducted an observational in High-risk patients requiring mitral valve surgery (n=88). Minimally invasive mitral valve surgery was evaluated on Survival at 6 years (95% CI 69-88). In high-risk patients (logistic EuroSCORE ≥20), minimally invasive mitral valve surgery resulted in 11.2% in-hospital mortality and a 6-year survival rate of 78% (95% CI, 69-88).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: