Kbiri Hicham, Seddiki Rachid, Chlouchi Abdellatif, Bouhabba Najib, Meskine Amine, Ababou Mourad, Qamouss Youssef, Khallkane S
Cardiothoracic Anesthesiology, Intensive Care Unit, and Emergency, Avicenna Military Hospital, Marrakech, MAR.
Anesthesia and Critical Care, Avicenna Training Military Hospital, Marrakesh, MAR.
Cureus. 2025 Jun 21;17(6):e86482. doi: 10.7759/cureus.86482. eCollection 2025 Jun.
Background and objectives This study aimed to compare surgical outcomes, early postoperative complications, and midterm recovery in patients with severe rheumatic mitral insufficiency undergoing either minimally invasive cardiac surgery (MICS) or mitral valve replacement via conventional median sternotomy (CMS). While CMS remains the standard approach, MICS has emerged as a less invasive option with potential benefits. However, comparative data in resource-limited settings remain scarce. Methods This multicenter retrospective study included 55 adults with severe rheumatic mitral Insufficiency (RMI) who underwent elective mechanical mitral valve replacement between 2020 and 2024 in Morocco. Patients were divided into two groups: 27 received minimally invasive surgery (MICS) via minithoracotomy, and 28 underwent conventional sternotomy (CMS). The primary endpoint was 30-day all-cause mortality. Secondary outcomes included operative times, postoperative complications, intensive care unit (ICU)/hospital stay duration, 12-month functional recovery, valve performance, and event-free survival based on Kaplan-Meier analysis. Results Fifty-five patients underwent mechanical mitral valve replacement: 27 via minimally invasive cardiac surgery (MICS) and 28 via conventional median sternotomy (CMS). The 30-day mortality was similar between groups (3.7% vs 3.6%; p = .99). Compared with CMS, MICS was associated with significantly shorter cardiopulmonary bypass (68.3 vs 87.5 minutes; p < .001) and aortic cross-clamp times (54.7 vs 77.1 minutes; p < .001), reduced postoperative pneumonia (0% vs 10.7%; p = .03), and fewer arrhythmias (7.4% vs 39.3%; p = .04). Hospital stay was shorter in the MICS group (6.2 vs 7.3 days; p = .04), with similar ICU duration. At 12 months, both groups showed preserved left ventricular ejection fraction (60.1% vs 58.2%; p = .22) and comparable event-free survival (>90%), without significant differences in valve-related complications. Conclusions In this multicenter retrospective study, minimally invasive cardiac surgery (MICS) for severe rheumatic mitral insufficiency was associated with fewer early complications, shorter operative and recovery times, and equivalent 12-month outcomes compared with conventional median sternotomy. These findings support MICS as a safe and effective alternative in appropriately selected patients when performed in experienced surgical centers.
背景与目的 本研究旨在比较接受微创心脏手术（MICS）或经传统正中胸骨切开术（CMS）进行二尖瓣置换术的重度风湿性二尖瓣关闭不全患者的手术效果、术后早期并发症及中期恢复情况。虽然CMS仍是标准术式，但MICS已成为一种侵入性较小的选择，具有潜在益处。然而，在资源有限的环境中，比较数据仍然稀缺。方法 这项多中心回顾性研究纳入了55例2020年至2024年在摩洛哥接受择期机械二尖瓣置换术的重度风湿性二尖瓣关闭不全（RMI）成人患者。患者分为两组：27例通过微创开胸手术（MICS），28例接受传统胸骨切开术（CMS）。主要终点是30天全因死亡率。次要结局包括手术时间、术后并发症、重症监护病房（ICU）/住院时间、12个月功能恢复、瓣膜性能以及基于Kaplan-Meier分析的无事件生存率。结果 55例患者接受了机械二尖瓣置换术：27例通过微创心脏手术（MICS），28例通过传统正中胸骨切开术（CMS）。两组30天死亡率相似（3.7%对3.6%；p = 0.99）。与CMS相比，MICS的体外循环时间显著缩短（68.3分钟对87.5分钟；p < 0.001），主动脉阻断时间缩短（54.7分钟对77.1分钟；p < 0.001），术后肺炎发生率降低（0%对10.7%；p = 0.03），心律失常发生率降低（7.4%对39.3%；p = 0.04）。MICS组住院时间较短（6.2天对7.3天；p = 0.04），ICU住院时间相似。12个月时，两组左心室射血分数均保持良好（60.1%对58.2%；p = 0.22），无事件生存率相当（>90%），瓣膜相关并发症无显著差异。结论 在这项多中心回顾性研究中，与传统正中胸骨切开术相比，重度风湿性二尖瓣关闭不全的微创心脏手术（MICS）早期并发症更少，手术和恢复时间更短，12个月结局相当。这些发现支持在经验丰富的手术中心对适当选择的患者，MICS是一种安全有效的替代方法。
