Abstract
Background and objectives: Certain clinical and anatomical conditions are absolute or relative contraindications for safe mitral valve surgery via the right mini-thoracotomy access. It is uncertain whether patients with these contraindications may benefit from the less invasive approach via upper hemi-sternotomy compared to standard full sternotomy. Materials and methods: Out of 2052 mitral valve surgery patients, operated from 6/04 through 2/19, 1535 were excluded due to the different criteria for eligibility to both approaches. Out of these, 350 received full sternotomy and 167 upper hemi-sternotomy. After propensity score matching, 164 pairs were analyzed for operative variables, postoperative complications and 30-day and one-year survival. Results: Upper hemi-sternotomy was associated with a survival benefit of 30 days (99.4% vs. 82.1%; p < 0.001) and one-year (93.9% vs. 79.9% p < 0.001, HR 0.26, 95% CI 0.14–0.49). Cardiopulmonary bypass and aortic cross-clamp times were comparable in both groups. Upper hemi-sternotomy resulted in less low cardiac output syndrome (18.9% vs. 31.1%; p = 0.011); ventilation time (8 vs. 13 h; p < 0.001), length of intensive care stay (1 vs. 2 days; p < 0.001) and total hospital stay (8 vs. 9 days; p < 0.001) were shorter in the upper hemi-sternotomy group. Conclusion: In patients undergoing mitral valve surgery, upper hemi-sternotomy is associated with short- and mid-term survival benefits as well as lower postoperative complication rates compared to full sternotomy. Hence, the less invasive upper hemi-sternotomy can be a valid approach in patients with contraindications for right mini-thoracotomy.
Highlights
In most dedicated centers the preferred access for isolated mitral valve surgery in patients with an acceptable risk profile is right mini-thoracotomy [1,2,3,4]
After propensity score matching the systolic pulmonary arterial pressure was significantly lower in the upper hemi-sternotomy cohort (45 mmHg vs. 50 mmHg, p = 0.024)
The prevalence of hospitalization for acute heart failure before surgery was higher in the upper hemi-sternotomy cohort (12.8% vs. 5.5%, p = 0.022)
Summary
In most dedicated centers the preferred access for isolated mitral valve surgery in patients with an acceptable risk profile is right mini-thoracotomy [1,2,3,4]. Certain clinical and anatomical conditions are limitations for safe mitral valve surgery with this access. Certain clinical and anatomical conditions are absolute or relative contraindications for safe mitral valve surgery via the right mini-thoracotomy access. It is uncertain whether patients with these contraindications may benefit from the less invasive approach via upper hemi-sternotomy compared to standard full sternotomy. Conclusion: In patients undergoing mitral valve surgery, upper hemisternotomy is associated with short- and mid-term survival benefits as well as lower postoperative complication rates compared to full sternotomy. The less invasive upper hemi-sternotomy can be a valid approach in patients with contraindications for right mini-thoracotomy
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.