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The Journal of Cardiovascular Surgery 2022 December;63(6):724-33

DOI: 10.23736/S0021-9509.22.12397-9

Copyright © 2022 THE AUTHORS

This is an open access article distributed under the terms of the CC BY-NC 4.0 license which allows users to distribute, remix, adapt and build upon the manuscript, as long as this is not done for commercial purposes, the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI), provides a link to the license and indicates if changes were made.

language: English

Propensity-matched comparison of right mini-thoracotomy versus median sternotomy for isolated mitral valve repair

Sabet W. HASHIM 1, Sean R. MCMAHON 1, Irena K. VAITKEVICIUTE 1, Susan COLLAZO 1, Isabelle M. HASHIM 2, Deborah S. LOYA 1, Edmund T. TAKATA 3 , Jeff F. MATHER 4, Raymond G. MCKAY 1

1 Hartford Health Care Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA; 2 Tufts University School of Medicine, Boston, MA, USA; 3 Integrated Anesthesia Associates, Hartford Hospital, Hartford, CT, USA; 4 Research Administration, Hartford Hospital, Hartford, CT, USA

BACKGROUND: A right mini-thoracotomy (RT) versus median sternotomy (MS) approach for isolated mitral valve (MV) repair has been associated with less postoperative morbidity, shorter hospital stay, and faster functional recovery, but with consistently longer cross-clamp time and higher operative costs.
METHODS: We assessed the impact of a modified operative technique on outcomes in 158 RT versus 129 MS patients treated with myxomatous MV repair from 2016 through 2021. Propensity matching based upon the Society of Thoracic Surgeons Risk Score was used to compare 108 patients in each cohort.
RESULTS: Propensity-matched RT patients had reductions in total ventilation time (P=0.025), postoperative atrial fibrillation (P=0.019), and hospital length of stay (P<0.001). RT and MS patients had similar cross-clamp times (66.4±13.7 vs 64.8±16.0 minutes, P=0.414), with less overall leaflet resection (32.4% vs 57.4%, P<0.001) and fewer Gore-Tex NeoChords implanted per patient (1.7±0.7 vs 2.1±1.0, P=0.028) in the RT group. The two cohorts did not differ with respect to 30-day major surgical complications. No patient died and there was no difference between the two groups with respect to freedom from re-operation (98.2% vs 98.2%, P=0.800) at a mean follow-up of 21.4±18.5 months. Direct total hospital costs were lower for the RT group (P=0.018), with reductions in postoperative charges offsetting increased operating room costs.
CONCLUSIONS: In this single-center study, the RT compared to the MS approach for myxomatous MV repair resulted in less postoperative morbidity and shorter hospital length of stay, with similar cross-clamp time, reduced total hospital costs, and comparable intermediate outcomes.

KEY WORDS: Mitral valve; Mitral valve insufficiency; Mitral valve annuloplasty; Surgical procedures, minimally invasive

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