Saipia Pongsaya, Tungjitviboonkun Songphol
Department of Surgery, Chulalongkorn University, Bangkok, THA.
School of Medicine, University of California San Francisco, San Francisco, USA.
Cureus. 2025 Apr 7;17(4):e81859. doi: 10.7759/cureus.81859. eCollection 2025 Apr.
Minimally invasive mitral valve surgery (MiMVS), particularly via right mini-thoracotomy, has gained popularity as an alternative to median sternotomy, potentially reducing surgical trauma and recovery time. However, recent data on its surgical outcomes remain limited. To provide updated insights while minimizing selection bias, we analyzed elective patients undergoing mitral valve surgery, comparing MiMVS and sternotomy in terms of survival, operative times, and perioperative complications.
We conducted a single-center retrospective cohort study that included patients who underwent mitral valve surgery between 2015 and 2024. Patients were stratified into MiMVS or sternotomy groups. Kaplan-Meier survival curves and log-rank tests assessed survival, while propensity score matching (PSM) minimized selection bias.
Among 422 patients (319 MiMVS, 103 sternotomy), the MiMVS group had a shorter hospital stay (5.0 vs. 8.0 days, p < 0.01) and lower postoperative bleeding (3.9% vs. 9%). Median cross-clamp and cardiopulmonary bypass (CPB) times were shorter in MiMVS (76 vs. 94 min, p < 0.01; and 114 vs. 140 min, p < 0.01, respectively). Survival analysis showed no significant difference between groups (log-rank p = 0.07) after PSM. The adjusted hazard ratio for mortality in MiMVS versus sternotomy was 0.30 (95% CI: 0.08-1.12, p = 0.07). However, mitral replacement was associated with a significantly higher mortality risk than mitral repair (HR 5.22, 95% CI: 1.26-21.61, p = 0.04). In-hospital mortality was comparable (1.9% for sternotomy vs. 0.6% for MiMVS, p = 0.25). Reoperation rates at five and 10 years were lower in MiMVS (1.7% vs. 2.1% at five years and 1.7% vs. 3.2% at 10 years).
While MiMVS offers advantages such as shorter hospital stays and lower postoperative bleeding rates, no statistically significant difference in overall survival was found compared to sternotomy. However, a trend toward improved survival with MiMVS was observed. Notably, mitral valve replacement was associated with a significantly higher mortality risk than mitral repair, emphasizing the importance of prioritizing repair whenever feasible.
微创二尖瓣手术（MiMVS），尤其是经右胸小切口手术，作为正中胸骨切开术的替代方法已越来越受欢迎，有可能减少手术创伤和恢复时间。然而，关于其手术结果的最新数据仍然有限。为了在尽量减少选择偏倚的同时提供最新见解，我们分析了接受二尖瓣手术的择期患者，比较了MiMVS和胸骨切开术在生存率、手术时间和围手术期并发症方面的差异。
我们进行了一项单中心回顾性队列研究，纳入了2015年至2024年间接受二尖瓣手术的患者。患者被分为MiMVS组或胸骨切开术组。采用Kaplan-Meier生存曲线和对数秩检验评估生存率，同时倾向得分匹配（PSM）尽量减少选择偏倚。
在422例患者中（319例MiMVS，103例胸骨切开术），MiMVS组住院时间较短（5.0天对8.0天，p<0.01），术后出血较少（3.9%对9%）。MiMVS组的平均主动脉阻断时间和体外循环（CPB）时间较短（分别为76分钟对94分钟，p<0.01；114分钟对140分钟，p<0.01）。生存分析显示，PSM后两组之间无显著差异（对数秩p=0.07）。MiMVS与胸骨切开术相比，调整后的死亡风险比为0.30（95%CI：0.08-1.12，p=0.07）。然而，二尖瓣置换术的死亡风险显著高于二尖瓣修复术（HR 5.22，95%CI：1.26-21.61，p=0.04）。院内死亡率相当（胸骨切开术为1.9%，MiMVS为0.6%，p=0.25）。MiMVS在5年和10年的再次手术率较低（5年时为1.7%对2.1%，10年时为1.7%对3.2%）。
虽然MiMVS具有住院时间短和术后出血率低等优点，但与胸骨切开术相比，总体生存率无统计学显著差异。然而，观察到MiMVS有生存改善的趋势。值得注意的是，二尖瓣置换术的死亡风险显著高于二尖瓣修复术，强调了在可行时优先进行修复的重要性。
