Long term outcomes of minimally invasive versus conventional sternotomy for mitral valve surgery

Tóm tắt

Background

Minimally invasive mitral valve surgery (MI) is a well-established technique with the goal of avoiding a sternotomy and its associated complications and reducing patient recovery time. Multiple studies have demonstrated similar early outcomes and safety of MI as compared to the median sternotomy (MS) however to date, long term outcomes have been less clearly established. To our knowledge this is the first meta-analysis looking at long-term outcomes of MI versus MS for mitral valve surgery

Methods

A search of three online medical databases was performed capturing studies from inception to June 2023. All studies reporting on long term outcomes of patients undergoing mitral valve surgery via a MI versus a MS approach were included. Reconstructed individual patient data was utilised to perform an enhanced secondary survival analysis.

Results

14 studies were included with a total of 10,382 patients. Mitral valve repair was performed in 86% and 78% of the MI and MS groups respectively. Survival at two, four, six and eight years was 95.8%, 93.3%, 89.7% and 86.9% for the MI group and 94%, 90.8%, 85.7% and 78.8% for the MS group. A significant difference in survival favouring MI group was evident by four years (p<0.001). Freedom from reintervention at two, four, six and eight years for the MI group was 96.9%, 96.1%, 95% and 93.3% and for the MS group 98.3%, 97.2%, 96.9% and 96.9%.

Conclusion

With appropriate patient selection and surgeon experience minimally invasive approaches to mitral valve repair provides excellent long-term survival and freedom from reintervention.