title: Minimally invasive approach provides at least equivalent results for surgical correction of mitral regurgitation: a propensity-matched comparison.
abstract: OBJECTIVE
  Minimally invasive approaches to mitral valve surgery are increasingly used, but the surgical approach must not compromise the clinical outcome for improved cosmesis. We examined the outcomes of mitral repair performed through right minithoracotomy or median sternotomy.
  
  
  METHODS
  Between January 2002 and October 2011, 1011 isolated mitral valve repairs were performed in the University of Pennsylvania health system (455 sternotomies, 556 right minithoracotomies). To account for key differences in preoperative risk profiles, propensity scores identified 201 well-matched patient pairs with mitral regurgitation of any cause and 153 pairs with myxomatous disease.
  
  
  RESULTS
  In-hospital mortality was similar between propensity-matched groups (0% vs 0% for the degenerative cohort; 0% vs 0.5%, P = .5 for the overall cohort; in minimally invasive and sternotomy groups, respectively). Incidence of stroke, infection, myocardial infarction, exploration for postoperative hemorrhage, renal failure, and atrial fibrillation also were comparable. Transfusion was less frequent in the minimally invasive groups (11.8% vs 20.3%, P = .04 for the degenerative cohort; 14.0% vs 22.9%, P = .03 for the overall cohort), but time to extubation and discharge was similar. A 99% repair rate was achieved in patients with myxomatous disease, and a minimally invasive approach did not significantly increase the likelihood of a failed repair resulting in mitral valve replacement. Patients undergoing minimally invasive mitral repair were more likely to have no residual post-repair mitral regurgitation (97.4% vs 92.1%, P = .04 for the degenerative cohort; 95.5% vs 89.6%, P = .02 for the overall cohort). In the overall matched cohort, early readmission rates were higher in patients undergoing sternotomies (12.6% vs 4.4%, P = .01). Over 9 years of follow-up, there was no significant difference in long-term survival between groups (P = .8).
  
  
  CONCLUSIONS
  In appropriate patients with isolated mitral valve disease of any cause, a right minithoracotomy approach may be used without compromising clinical outcome.
authors: Department of Surgery, Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
authors: Andrew B
authors: AB
authors: Goldstone
authors: Pavan
authors: P
authors: Atluri
authors: Wilson Y
authors: WY
authors: Szeto
authors: Alen
authors: A
authors: Trubelja
authors: Jessica L
authors: JL
authors: Howard
authors: John W
authors: JW
authors: MacArthur
authors: Craig
authors: C
authors: Newcomb
authors: Joseph P
authors: JP
authors: Donnelly
authors: Dale M
authors: DM
authors: Kobrin
authors: Mary A
authors: MA
authors: Sheridan
authors: Christiana
authors: C
authors: Powers
authors: Robert C
authors: RC
authors: Gorman
authors: Joseph H
authors: JH
authors: Gorman
authors: Alberto
authors: A
authors: Pochettino
authors: Joseph E
authors: JE
authors: Bavaria
authors: Michael A
authors: MA
authors: Acker
authors: W Clark
authors: WC
authors: Hargrove
authors: Y Joseph
authors: YJ
authors: Woo
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D004452:Echocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D057216:Propensity Score; D018709:Statistics, Nonparametric; D056346:Sternotomy; D013908:Thoracotomy; D016896:Treatment Outcome