Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.
Department of Cardiothoracic Anaesthesia, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.
Interact Cardiovasc Thorac Surg. 2021 Apr 8;32(3):433-440. doi: 10.1093/icvts/ivaa276.
To compare patient-reported outcome measures of minimally invasive (MI) to sternotomy (ST) mitral valve repair.
We included all patients undergoing isolated mitral valve surgery via either a right mini-thoracotomy (MI) or ST over a 36-month period. Patients were asked to complete a modified Composite Physical Function questionnaire. Intraoperative and postoperative outcomes, and patient-reported outcome measures were compared between 2 propensity-matched groups (n = 47/group), assessing 3 domains: 'Recovery Time', 'Postoperative Pain' (at day 2 and 1, 3, 6 and 12 weeks) and 'Treatment Satisfaction'. Composite scores for each domain were subsequently constructed and multivariable analysis was used to determine whether surgical approach was associated with domain scores.
The response rate was 79%. There was no mortality in either group. In the matched groups, operative times were longer in the MI group (P < 0.001), but postoperative outcomes were similar. Composite scores for Recovery Time [ST 51.7 (31.8-62.1) vs MI 61.7 (43.1-73.9), P = 0.03] and Pain [ST 65.7 (40.1-83.1) vs MI 79.1 (65.5-89.5), P = 0.02] significantly favoured the MI group. Scores in the Treatment Satisfaction domain were high for both surgical approaches [ST 100 (82.5-100) vs MI 100 (95.0-100), P = 0.15]. The strongest independent predictor of both faster recovery parameter estimate 12.0 [95% confidence interval (CI) 5.7-18.3, P < 0.001] and less pain parameter estimate 7.6 (95% CI 0.7-14.5, P = 0.03) was MI surgery.
MI surgery was associated with faster recovery and less pain; treatment satisfaction and safety profiles were similar.
比较微创（MI）与胸骨切开（ST）二尖瓣修复的患者报告结局测量值。
我们纳入了在 36 个月内通过右微创（MI）或 ST 接受单独二尖瓣手术的所有患者。要求患者完成改良的综合身体功能问卷。比较了 2 个倾向匹配组（每组 47 例）的术中及术后结果和患者报告的结局测量值，评估了 3 个领域：“恢复时间”、“术后疼痛”（第 2 天和第 1、3、6 和 12 周）和“治疗满意度”。随后构建了每个领域的综合评分，并进行了多变量分析以确定手术方法是否与领域评分相关。
回复率为 79%。两组均无死亡。在匹配组中，MI 组的手术时间更长（P<0.001），但术后结果相似。恢复时间综合评分[ST 51.7（31.8-62.1）与 MI 61.7（43.1-73.9），P=0.03]和疼痛评分[ST 65.7（40.1-83.1）与 MI 79.1（65.5-89.5），P=0.02]均明显倾向于 MI 组。两种手术方法的治疗满意度评分均较高[ST 100（82.5-100）与 MI 100（95.0-100），P=0.15]。更快恢复参数估计值 12.0[95%置信区间（CI）5.7-18.3，P<0.001]和更少疼痛参数估计值 7.6（95%CI 0.7-14.5，P=0.03）的最强独立预测因素均为 MI 手术。
MI 手术与更快的恢复和更少的疼痛相关；治疗满意度和安全性相似。
