Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands.
Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands.
Eur J Cardiothorac Surg. 2022 May 2;61(5):1099-1106. doi: 10.1093/ejcts/ezab507.
Minimally invasive mitral valve surgery (MIMVS) has been performed increasingly for the past 2 decades; however, large comparative studies on short- and long-term outcomes have been lacking. This study aims to compare short- and long-term outcomes of patients undergoing MIMVS versus median sternotomy (MST) based on real-world data, extracted from the Netherlands Heart Registration.
Patients undergoing mitral valve surgery, with or without tricuspid valve, atrial septal closure and/or rhythm surgery between 2013 and 2018 were included. Primary outcomes were short-term morbidity and mortality and long-term survival. Propensity score matching analyses were performed.
In total, 2501 patients were included, 1776 were operated through MST and 725 using an MIMVS approach. After propensity matching, no significant differences in baseline characteristics persisted. There were no between-group differences in 30-day mortality (1.1% vs 0.7%, P = 0.58), 1-year mortality (2.6% vs 2.1%, P = 0.60) or perioperative stroke rate (1.1% vs 0.6%, P = 0.25) between MST and MIMVS, respectively. An increased rate of postoperative arrhythmia was observed in the MST group (31.3% vs 22.4%, P < 0.001). A higher repair rate was found in the MST group (80.9% vs 76.3%, P = 0.04). No difference in 5-year survival was found between the matched groups (95.0% vs 94.3%, P = 0.49). Freedom from mitral reintervention was 97.9% for MST and 96.8% in the MIMVS group (P = 0.01), without a difference in reintervention-free survival (P = 0.30).
The MIMVS approach is as safe as the sternotomy approach for the surgical treatment of mitral valve disease. However, it comes at a cost of a reduced repair rate and more reinterventions in the long term, in the real-world.
微创二尖瓣手术（MIMVS）在过去 20 年中得到了越来越多的应用；然而，对于短期和长期结果的大型比较研究一直缺乏。本研究旨在根据荷兰心脏登记处提取的真实世界数据，比较 MIMVS 与正中胸骨切开术（MST）治疗二尖瓣疾病的短期和长期结果。
纳入 2013 年至 2018 年间接受二尖瓣手术（伴或不伴三尖瓣、房间隔闭合和/或节律手术）的患者。主要结局为短期发病率和死亡率以及长期生存率。进行了倾向评分匹配分析。
共纳入 2501 例患者，其中 1776 例行 MST，725 例行 MIMVS。在倾向评分匹配后，两组间基线特征无显著差异。两组间 30 天死亡率（1.1%比 0.7%，P=0.58）、1 年死亡率（2.6%比 2.1%，P=0.60）或围手术期卒中发生率（1.1%比 0.6%，P=0.25）无差异。MST 组术后心律失常发生率增加（31.3%比 22.4%，P<0.001）。MST 组修复率较高（80.9%比 76.3%，P=0.04）。两组 5 年生存率无差异（95.0%比 94.3%，P=0.49）。MST 组二尖瓣再干预率为 97.9%，MIMVS 组为 96.8%（P=0.01），再干预无事件生存率无差异（P=0.30）。
MIMVS 方法与胸骨切开术治疗二尖瓣疾病一样安全。然而，在真实世界中，它的长期修复率较低，需要更多的干预。
