RIGHT MINI-THORACOTOMY VERSUS STERNOTOMY FOR REDO MITRAL VALVE SURGERY: A PROPENSITY SCORE ANALYSIS
Presented During:
Thursday, May 4, 2023: 6:30PM - Saturday, May 6, 2023: 2:29AM
New York Hilton Midtown
Posted Room Name:
Grand Ballroom Foyer
Abstract No:
MP056
Submission Type:
Abstract Submission
Authors:
Cristina Barbero (1), Claudia Calia (2), Marco Pocar (2), Dario Brenna (2), Valentina Aloi (2), Erik Cura Stura (2), Claudia Filippini (3), Stefano Salizzoni (4), Mauro Rinaldi (5)
Institutions:
(1) 1Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Italy, Torino, Italy, (2) Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy, Torino, NA, (3) Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy, Torino, TO, (4) N/A, Turin, Italy, (5) AO Citta' della Salute e della Scienza di Torino, Torino
Submitting Author:
Cristina Barbero
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1Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Italy
1Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Italy
Co-Author(s):
Claudia Calia
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Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
Marco Pocar
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Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
Dario Brenna
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Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
Valentina Aloi
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Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
Erik Cura Stura
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Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
Claudia Filippini
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Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
Stefano Salizzoni
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N/A
N/A
Mauro Rinaldi
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AO Citta' della Salute e della Scienza di Torino
AO Citta' della Salute e della Scienza di Torino
Presenting Author:
Cristina Barbero
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AO Citta' della Salute e della Scienza di Torino
AO Citta' della Salute e della Scienza di Torino
Abstract:
Background
Redo MV surgery represents one of the most challenging and high-risk procedure in cardiac surgery. The presence of dense adhesions, and the high probability of grafts, heart, and great vessels injuries make these operations demanding through a median sternotomy. Conversely, the right mini-thoracotomy (MT) approach is able to offer the surgeon the possibility to minimize the surgical trauma, to avoid re-sternotomy-related injuries, to reduce the need for extensive and time-consuming dissection of adhesions, and to improve the MV exposure.
Aim of this study is to compare the MT with the re-sternotomy approach in terms of short and long-term results in patients undergoing redo MV surgery.
Methods. Data of patients undergoing redo MV surgery from 2006 to 2021 were prospectively collected and retrospectively analyzed. Inclusion criteria were prior operations through median sternotomy, and required MV surgery; associated procedures such as tricuspid surgery and atrial fibrillation ablation were considered suitable for enrollment. To reduce possible differences between groups, a propensity score analysis was performed using greedy nearest neighbor matching without replacement. Kaplan-Meier curves were used to estimate freedom from death and re-operation, and compared using the Log-rank test.
Results. 488 patients were enrolled: 337 underwent surgery via MT and 151 via re-sternotomy. The estimated propensity score analysis based on 16 clinically relevant demographics variable resulted in 138 well-matched patient pairs. No differences were recorded in terms of 30-day mortality, stroke, re-exploration for bleeding and freedom from reoperation at follow-up. Mechanical ventilation time (11.4 vs 14 hours, p=.04), and ICU length-of-stay (1 vs 2 days, p=.02) were shorter in the MT group; pneumonia (14 vs 33%, p=.002), minor neurological events (1 vs 10%, p=.006), and long-term mortality (Figure) were lower in the MT group.
Conclusion. This analysis clearly shows better early and long-term outcome of the MT approach in redo MV surgery patients when compared with the sternotomy approach. A rigorous preoperative screening and experience on different minimally invasive setting of arterial perfusion and aortic clamping is mandatory to reach safe results.
Redo MV surgery represents one of the most challenging and high-risk procedure in cardiac surgery. The presence of dense adhesions, and the high probability of grafts, heart, and great vessels injuries make these operations demanding through a median sternotomy. Conversely, the right mini-thoracotomy (MT) approach is able to offer the surgeon the possibility to minimize the surgical trauma, to avoid re-sternotomy-related injuries, to reduce the need for extensive and time-consuming dissection of adhesions, and to improve the MV exposure.
Aim of this study is to compare the MT with the re-sternotomy approach in terms of short and long-term results in patients undergoing redo MV surgery.
Methods. Data of patients undergoing redo MV surgery from 2006 to 2021 were prospectively collected and retrospectively analyzed. Inclusion criteria were prior operations through median sternotomy, and required MV surgery; associated procedures such as tricuspid surgery and atrial fibrillation ablation were considered suitable for enrollment. To reduce possible differences between groups, a propensity score analysis was performed using greedy nearest neighbor matching without replacement. Kaplan-Meier curves were used to estimate freedom from death and re-operation, and compared using the Log-rank test.
Results. 488 patients were enrolled: 337 underwent surgery via MT and 151 via re-sternotomy. The estimated propensity score analysis based on 16 clinically relevant demographics variable resulted in 138 well-matched patient pairs. No differences were recorded in terms of 30-day mortality, stroke, re-exploration for bleeding and freedom from reoperation at follow-up. Mechanical ventilation time (11.4 vs 14 hours, p=.04), and ICU length-of-stay (1 vs 2 days, p=.02) were shorter in the MT group; pneumonia (14 vs 33%, p=.002), minor neurological events (1 vs 10%, p=.006), and long-term mortality (Figure) were lower in the MT group.
Conclusion. This analysis clearly shows better early and long-term outcome of the MT approach in redo MV surgery patients when compared with the sternotomy approach. A rigorous preoperative screening and experience on different minimally invasive setting of arterial perfusion and aortic clamping is mandatory to reach safe results.
Mitral Conclave:
Mitral & Tricuspid Valve Reoperations
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