Early Outcome of Minimally Invasive Versus Median Sternotomy Mitral Valve Replacement In Patients With Severe Chronic Obstructive Pulmonary Disease

Abstract

Background: Minimally invasive valve surgery is considered much more beneficial than routine median sternotomy in patients undergoing open heart surgery with sever chronic obstructive pulmonary disease (COPD). Objective: To compare between early outcomes of minimally invasive versus routine median sternotomy in patients with severe COPD undergoing isolated mitral valve replacement (MVR). Patients and Methods: 100 patients with severe COPD between October 2016 and September 2019 underwent isolated MVR. Patients were divided into 2 groups: Group (A): 50 patients underwent surgery via minimally invasive approach and group (B): 50 patients underwent surgery via median sternotomy. Early postoperative complications, Intensive Care Unit stay and total hospital stay were compared in both groups. Results: The mean age was 60 ± 9 years for Group (A) and 61 ± 10 years for Group (B), (P = 0.29). Combined postoperative complications were significantly lower in Group (A) [8 (16%) versus 12 (24%), P < 0.05]. The median postoperative mechanical ventilation time was 10 hours in group (A) versus 22 hours in group (B) (P < 0.05). The median ICU stay in group (A) was 1.5 days versus 3 days in group (B) (P < 0.05). The median length of total hospital stay was 7 days in group (A) versus 13 days in group (B) (P < 0.05). The overall hospital mortality was 2 patients (4%) in group (A) versus 1 patient (2%) in group (B) P < 0.05. Conclusion: Minimally invasive had better early outcome than routine median sternotomy in patients with severe COPD undergoing MVR and should be considered as a good option in these patients.