Jae Suk Yoo1, Joon Bum Kim1, Sung-Ho Jung1, Suk Jung Choo1, Cheol Hyun Chung1, Jae Won Lee2. 1. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea. 2. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea. Electronic address: jwlee@amc.seoul.kr.
Abstract
OBJECTIVE: To compare the long-term echocardiographic mitral valve (MV) durability after MV repair performed through a minithoracotomy versus conventional sternotomy. METHODS: A total of 299 patients who underwent MV repair for degenerative mitral regurgitation (MR) through minithoracotomy (n = 179) or sternotomy (n = 120), between April 2004 and January 2010, were evaluated. To adjust the differences in baseline characteristics between the 2 groups, weighted Cox proportional-hazards regression models and inverse-probability-of-treatment weighting were used. RESULTS: There were no 30-day deaths in both groups and no significant differences in early complication rates. Clinical follow-up was complete in 294 patients (98.3%), with a median follow-up of 55.4 months (interquartile range, 34.4-66.9 months), during which there were 10 late deaths, 2 strokes, and 3 reoperations for recurrent MR. After adjustment, the minithoracotomy group had similar risks for major adverse cardiac events (hazard ratio, 0.77; 95% confidence interval, 0.22-2.68; P = .68). Echocardiographic evaluation in the late period (>6 months) was possible in 292 patients (97.7%), with a median follow-up of 29.4 months (interquartile range, 13.3-49.7 months), during which 21 patients (12 in the minithoracotomy group and 9 in the sternotomy group) experienced significant MR (>2+). Freedom from significant MR at 5 years was 86.1% ± 4.8% versus 85.3% ± 5.5% (P = .63). After adjustment, the minithoracotomy group had similar risks for significant MR (hazard ratio, 0.81; 95% confidence interval, 0.31-2.14; P = .67). CONCLUSIONS: A minithoracotomy approach for MV repair showed comparable clinical outcomes and efficacy to conventional sternotomy for MV repair. Crown
OBJECTIVE: To compare the long-term echocardiographic mitral valve (MV) durability after MV repair performed through a minithoracotomy versus conventional sternotomy. METHODS: A total of 299 patients who underwent MV repair for degenerative mitral regurgitation (MR) through minithoracotomy (n = 179) or sternotomy (n = 120), between April 2004 and January 2010, were evaluated. To adjust the differences in baseline characteristics between the 2 groups, weighted Cox proportional-hazards regression models and inverse-probability-of-treatment weighting were used. RESULTS: There were no 30-day deaths in both groups and no significant differences in early complication rates. Clinical follow-up was complete in 294 patients (98.3%), with a median follow-up of 55.4 months (interquartile range, 34.4-66.9 months), during which there were 10 late deaths, 2 strokes, and 3 reoperations for recurrent MR. After adjustment, the minithoracotomy group had similar risks for major adverse cardiac events (hazard ratio, 0.77; 95% confidence interval, 0.22-2.68; P = .68). Echocardiographic evaluation in the late period (>6 months) was possible in 292 patients (97.7%), with a median follow-up of 29.4 months (interquartile range, 13.3-49.7 months), during which 21 patients (12 in the minithoracotomy group and 9 in the sternotomy group) experienced significant MR (>2+). Freedom from significant MR at 5 years was 86.1% ± 4.8% versus 85.3% ± 5.5% (P = .63). After adjustment, the minithoracotomy group had similar risks for significant MR (hazard ratio, 0.81; 95% confidence interval, 0.31-2.14; P = .67). CONCLUSIONS: A minithoracotomy approach for MV repair showed comparable clinical outcomes and efficacy to conventional sternotomy for MV repair. Crown
Authors: Rebecca H Maier; Adetayo S Kasim; Joseph Zacharias; Luke Vale; Richard Graham; Antony Walker; Grzegorz Laskawski; Ranjit Deshpande; Andrew Goodwin; Simon Kendall; Gavin J Murphy; Vipin Zamvar; Renzo Pessotto; Clinton Lloyd; Malcolm Dalrymple-Hay; Roberto Casula; Hunaid A Vohra; Franco Ciulli; Massimo Caputo; Serban Stoica; Max Baghai; Gunaratnam Niranjan; Prakash P Punjabi; Olaf Wendler; Leanne Marsay; Cristina Fernandez-Garcia; Paul Modi; Bilal H Kirmani; Mark D Pullan; Andrew D Muir; Dimitrios Pousios; Helen C Hancock; Enoch Akowuah Journal: BMJ Open Date: 2021-04-14 Impact factor: 2.692