MP56. Right Mini-Thoracotomy Versus Sternotomy for Redo Mitral Valve Surgery: A Propensity Score Analysis
Presented During: Moderated E-Posters
AO Citta' della Salute e della Scienza di Torino
Torino, Turin
Italy - Contact Me
Consultant cardiothoracic surgeon at S. Giovanni Battista Hospital “Molinette”- Prof. M. Rinaldi (Feb 2018)
Turin University Doctoral School in Life and Health Sciences (PhD)– Technology applied to Surgical Sciences (January 2014 – December 2016).
Turin University Residency in Cardiac Surgery (June 2009 – June 2014)
Fields of interest:
- Minimally invasive mitral and tricuspid valve surgery.
- Advance heart failure and heart transplant.
Turin University Medical School, Italy (M.D., 2002-2008). Thesis: “Minimally invasive mitral valve surgery: mid term results” (score: 110/110 cum laude).
Surgical fellow in heart and lung transplant and mechanical circulatory support at Papworth Hospital NHS, Cambridge – UK (October 2014 – November 2015).
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
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.