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Current trends in mitral valve surgery: A multicenter national comparison between full-sternotomy and minimally-invasive approach
- Source :
- International Journal of Cardiology. 306:147-151
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Mitral valve surgery (MVS) is evolving. Compared to standard sternotomy (S-MVS), minimally invasive method (Mini-MVS) has been increasingly adopted in the last years with encouraging results for both repairs and replacements. We evaluated trends of surgical approaches and operative outcomes in a multicenter study involving 10 cardiac surgical centers in Italy.Patients who received isolated mitral valve surgery, including only a concomitant tricuspid valve repair, from January 2011 up to December 2017. Minimally invasive approach (right anterior mini-thoracotomy) and standard sternotomy was performed in 2602 and 1947 patients, respectively. Stratifying by surgery, 1493 patients per group were paired using a propensity matching procedure.The minimally invasive approach has been progressively more frequent over the years (from 27.5% in 2011 to 71.7% in 2017). Compared to S-MVS, Mini-MVS patients were younger with less preoperative comorbidities and less frequently operated for valve replacement or in association with tricuspid repair. The 30-day mortality was lower in the Mini-MVS (overall 1.2% vs 2.7%; p 0.001) as well as the incidence of most postoperative complications. Subjects paired by propensity score had similar 30-day mortality (1.9% vs 1.8%, p = 0.786) but lower blood transfusion and permanent pace-maker insertion. Cardiopulmonary bypass and cross-clamp time, initially longer in the Mini-MVS patients, became shorter in recent years for the minimally invasive approach.In a large multi-institutional recent cohort, minimally invasive mitral valve surgery has drastically increased being the preferred technique and appears to be safe with procedural duration shorter than the beginning.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Valve replacement
medicine
Humans
Minimally Invasive Surgical Procedures
030212 general & internal medicine
TRICUSPID VALVE REPAIR
Heart Valve Prosthesis Implantation
Surgical approach
business.industry
Length of Stay
Sternotomy
Cardiac surgery
Surgery
Treatment Outcome
Italy
Thoracotomy
Concomitant
Cohort
Propensity score matching
Mitral Valve
Cardiology and Cardiovascular Medicine
business
Mitral valve surgery
Subjects
Details
- ISSN :
- 01675273
- Volume :
- 306
- Database :
- OpenAIRE
- Journal :
- International Journal of Cardiology
- Accession number :
- edsair.doi.dedup.....859ce2bf740790b82c76c957c0cf96e1