Key result
Minimally invasive double-valve surgery linked to ~1.8 fewer ventilation hours versus conventional sternotomy.
Why the study?
Minimally invasive surgical techniques are being extended to concomitant aortic and mitral valve operations through a single small incision, prompting comparison of upper partial sternotomy approaching the mitral valve through the left atrial dome against conventional surgery.
Does minimally invasive combined aortic and mitral valve surgery via upper partial sternotomy and the left atrial dome improve postoperative recovery and reduce bleeding compared to conventional full median sternotomy?
Cohort (n=150)
No
Does minimally invasive combined aortic and mitral valve surgery via upper partial sternotomy and the left atrial dome improve postoperative recovery and reduce bleeding compared to conventional full median sternotomy?
Approaching the mitral valve via the left atrial dome through an upper partial sternotomy provides a safe, simple minimally invasive alternative for combined aortic and mitral valve surgery that reduces ventilation time, blood loss, and transfusion requirements without significantly prolonging operative times.
Answers are grounded in this paper and cite their sources.
May reduce ventilation time and blood loss after double valve surgery; leaves open need for randomized confirmation.
Background There is now extension of minimally invasive techniques to involve concomitantly aortic and mitral valves through a single small incision. We share our experience in such surgeries through upper partial sternotomy with approaching the mitral valve through the dome of the left atrium. Methods Two matched groups of cases receiving concomitant aortic and mitral valve surgeries are compared regarding the surgical outcomes: the minimally invasive group (group A) including 72 patients and the conventional group (group B) including 78 patients. Results The mean age was 52 ± 8 years in group A and 53 ± 7 years in group B. Males represented (42%) in group A and (49%) in group B. The mean mechanical ventilation time was significantly shorter in group A (4.3 ± 1.2 hours) than in group B (6.1 ± 0.8 hours) with a p-value of 0.001. In addition, the amount of chest tube drainage and the need for blood transfusion units were significantly less in group A (250 ± 160 cm3 and 1.3 ± 0.8 units, respectively) when compared with group B (320 ± 180 cm3 and 1.8 ± 0.9 units, respectively) with p-values of 0.013 and 0.005, respectively. Over a follow-up period of 3.2 ± 1.1 years, one mortality occurred in each group with no significant difference (p-value = 0.512). Conclusion Combined aortic and mitral valve surgery through upper partial sternotomy with approaching the mitral valve through the dome of the left atrium is safe and effective with the advantages of less postoperative blood loss, need for blood transfusion, and mechanical ventilation time compared with conventional aortic and mitral valve surgery.
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Alkady et al. (2021) conducted a cohort in Combined aortic and mitral valve disease (n=150). Minimally invasive combined aortic and mitral valve surgery via upper partial sternotomy and left atrial dome approach vs. Conventional combined aortic and mitral valve surgery via full median sternotomy was evaluated on Mechanical ventilation time (hours) (p=0.001). Minimally invasive double valve surgery via upper partial sternotomy reduced mechanical ventilation time (4.3 vs 6.1 hours, p=0.001) and blood loss compared to conventional sternotomy.
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