Early and mid-term outcomes of isolate mitral valve repair through minimal invasive versus median sternotomy ap-proach: a propensity-matched analysis / 中华胸心血管外科杂志

ABSTRACT

Objective The aim of the study was to compare the early and mid-term outcomes of isolate mitral valve repair through minimal invasive and median sternotomy approach .Methods From July 2009 to December 2015, 329 patients under-went minimal invasive isolated mitral valve repair through right thoracic approach at our institution .The mean age was(48 ±14) years(15-78 years), 202 patients(61.4％) were male and 137 patients(41.6％) were in NYHA class Ⅲ-Ⅳ.570 patients underwent isolate mitral valve repair through median sternotomy in the same period .Propensity score matching identify 248 pa-tient pairs with similar preoperative characteristics .Early and mid-term outcomes were compared between propensity-matched groups.Results After propensity matching, the mean cardiopulmonary bypass time[(91 ±27)min vs.(76 ±27)min, P<0.05] and aorta cross clamp time[(52 ±18)min vs.(43 ±15)min, P<0.05] were significantly longer in minimal invasive group.24 hours drainage volume was significantly less[(353 ±329)ml vs.(446 ±356)ml, P <0.05] and patients need transfusion was significantly fewer(22.2％ vs 31.5％, P<0.05) in minimal invasive group.Incidence of stroke, poor wound healing, renal failure requiring hemodialysis and tracheotomy were similar between the two groups(P>0.05).There were two in-hospital death in minimal invasive group(respiratory failure) and median sternotomy group(low cardiac output syndrome), respectively.Follow-up was 91％ complete and the mean follow-up time was(28 ±21) months(3-89 months).At 7 year after surgery, overall survival were 99％and 100％(P>0.05) in minimal invasive group and median sternotomy group, respective-ly.Freedom from reoperation were 100％ and 95％(P>0.05) and freedom from recurrent mitral regurgitation were 95％ and 90％(P>0.05).Conclusion Minimal invasive mitral valve repair was safe, effective and provide equivalent mid-term out-comes compared to median sternotomy approach .Minimal invasive surgery provided cosmetic benefits , decreased postoperative trauma.As the accumulation of clinical experience, complex repair is feasible through minimal invasive surgery.Adoption of minimal invasive surgery will increase the acceptance of early intervention strategy among asymptomatic MR patients and thus improve late outcomes and life quality .