Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands.
Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands.
Eur J Cardiothorac Surg. 2022 Oct 4;62(5). doi: 10.1093/ejcts/ezac420.
Mitral valve (MV) surgery after prior cardiac surgery is conventionally performed through resternotomy and associated with increased morbidity and mortality. Alternatively, MV can be approached minimally invasively [minimally invasive mitral valve surgery (MIMVS)], but longer-term follow-up of this approach for MV surgery after prior cardiac surgery is lacking. Therefore, the aim of the current study is to evaluate short- and mid-term outcomes of MIMVS versus MV surgery through resternotomy in patients with prior sternotomy, using a nationwide registry.
Patients undergoing isolated MV surgery after prior cardiac surgery between 2013 and 2018 were included. Primary outcomes were short-term morbidity and mortality and mid-term survival. Cox proportional hazard analysis was used to investigate the association between surgical approach and mortality. Propensity score matching was used to correct for potential confounders.
In total, 290 patients underwent MV surgery after prior cardiac surgery, of whom 205 patients were operated through resternotomy and 85 patients through MIMVS. No significant differences in 30-day mortality (3.4% vs 2%, P = 0.99) were observed between both groups. Five-year survival was 86.3% in the resternotomy group, compared to 89.4% in the MIMVS group (log-rank P = 0.45). In the multivariable analysis, surgical approach showed no relation with mid-term mortality [hazard ratio 0.73 (0.34-1.60); P = 0.44]. A lower incidence of prolonged intubation and new-onset arrhythmia was observed in MIMVS.
MV surgery after prior cardiac surgery has excellent short- and mid-term results in the Netherlands, and MIMVS and resternotomy appear to be equally efficacious. MIMVS is associated with a lower incidence of new-onset arrhythmia and prolonged intubation.
既往心脏手术后的二尖瓣（MV）手术传统上通过胸骨切开术进行，这与更高的发病率和死亡率相关。替代地，MV 可以通过微创方法进行[微创二尖瓣手术（MIMVS）]，但对于既往心脏手术后通过胸骨切开术进行 MV 手术的这种方法缺乏长期随访。因此，目前研究的目的是通过全国性登记处评估既往接受过胸骨切开术的患者中 MIMVS 与通过胸骨切开术进行 MV 手术的短期和中期结果。
纳入 2013 年至 2018 年间接受既往心脏手术后孤立性 MV 手术的患者。主要结果是短期发病率和死亡率以及中期存活率。Cox 比例风险分析用于研究手术方法与死亡率之间的关联。采用倾向评分匹配校正潜在混杂因素。
共 290 例患者接受了既往心脏手术后的 MV 手术，其中 205 例通过胸骨切开术，85 例通过 MIMVS 进行。两组 30 天死亡率（3.4%对 2%，P=0.99）无显著差异。胸骨切开术组 5 年生存率为 86.3%，MIMVS 组为 89.4%（对数秩 P=0.45）。在多变量分析中，手术方法与中期死亡率无关[风险比 0.73（0.34-1.60）；P=0.44]。MIMVS 组新发心律失常和延长插管的发生率较低。
荷兰既往心脏手术后的 MV 手术具有出色的短期和中期结果，MIMVS 和胸骨切开术似乎同样有效。MIMVS 与新发心律失常和延长插管的发生率较低相关。
