Document Detail

Minimally invasive versus sternotomy approach for mitral valve surgery: a propensity analysis.
MedLine Citation:
PMID:  20971243     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Over the past decade, minimally invasive (MI) mitral valve surgery has grown in popularity. The purpose of this study was to compare both short- and long-term outcomes of mitral valve repair and replacement performed through a MI versus traditional sternotomy (ST) incision using a propensity analysis approach to account for differences in baseline risk. METHODS: From January 2000 to December 2008, a total of 1,121 isolated mitral valve operations were performed at our institution (548 ST, 573 MI). Data were retrospectively collected on all patients, and a logistic regression model was created to predict selection to a MI versus ST approach. Propensity scores were then generated based on the regression model and matched pairs created using 1:1 nearest neighbor matching. There were 382 matched pairs in the analysis for a total sample size of 764, or 68.2% of the original cohort. Major outcomes of interest included cardiopulmonary bypass time, cross-clamp time, hospital length of stay, major in-hospital complications, and both short- and long-term survival. RESULTS: Cardiopulmonary bypass time was 117.1 ± 2.0 minutes in the ST group and 139.7 ± 2.6 minutes in the MI group (p < 0.0001), and cross-clamp time was 79.6 ± 1.5 minutes in the ST group and 83.7 ± 1.9 in the MI group (p = 0.106). The average hospital length of stay was 9.81 ± 0.61 days among ST patients and 7.76 ± 0.37 days among MI patients (p = 0.0043). There was no significant difference in the frequency of major in-hospital complications between groups. The mean duration of survival follow-up was 4.2 ± 2.4 years. There was no significant difference in mortality at 30 days (p = 0.622) or 1 year (p = 0.599). In addition, there was no significant difference in long-term survival between groups (p = 0.569). CONCLUSIONS: Although minimally invasive mitral valve surgery required a slightly longer cardiopulmonary bypass time, there was no difference in cross-clamp time, morbidity, or mortality, and hospital length of stay was significantly shorter when compared with matched sternotomy control patients.
Alexander Iribarne; Mark J Russo; Rachel Easterwood; Kimberly N Hong; Jonathan Yang; Faisal H Cheema; Craig R Smith; Michael Argenziano
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  90     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-25     Completed Date:  2010-11-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1471-7; discussion 1477-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
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MeSH Terms
Length of Stay
Middle Aged
Mitral Valve / surgery*
Propensity Score
Sternotomy / methods*
Surgical Procedures, Minimally Invasive / methods*
Treatment Outcome
Grant Support
5T32HL007854-13/HL/NHLBI NIH HHS

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