Minimally Invasive Mitral Valve Surgery Compared to Sternotomy in Patients Over 70 Years Old: A Retrospective Nationwide Multicentre Study in The Netherlands.

OBJECTIVES

Older patients are more prone to postoperative morbidity and mortality after mitral valve (MV) surgery. Minimally invasive MV surgery (MIMVS) is increasingly adopted worldwide, with a potential benefit in the elderly. This study compares short-term and mid-term outcomes in patients above 70 years, undergoing MIMVS versus median sternotomy (MST), in a nationwide registry.

METHODS

All patients above 70 years undergoing primary elective MV surgery (±tricuspid valve [TV] surgery, atrial septal defect closure, rhythm surgery) between 2013 and 2021 were included. All data were extracted from the Netherlands Heart Registration. Primary outcomes were short-term morbidity, mortality, and 5-year survival.

RESULTS

In total, 1418 patients were included (MST n = 797, MIMVS n = 621). No statistically significant differences in baseline characteristics were found. Median Logistic EuroSCORE I was 6.3 [4.7-8.5] vs 6.0 [4.6-8.5], P = .27 for MST and MIMVS, respectively. Mitral valve repair (77.7% vs 64.7% P < .001) and concomitant TV surgery (43.9% vs 18.2%, P < .001) was more frequently performed in MST. Lower 30-day mortality was observed in MIMVS (0.6% [n = 4] vs 2.5% [n = 21], P = .01). Furthermore, the incidence of pneumonia, prolonged intubation, readmission to intensive care unit, kidney failure, and new-onset arrhythmia were lower for MIMVS. No difference in 5-year survival was found (MST: 89.1 ± 4.6% vs MIMVS: 91.6 ± 4.7% Log-Rank P = .51).

CONCLUSIONS

Minimally invasive MV surgery in patients above 70 years may be associated with lower 30-day mortality and incidence of postoperative complications compared with sternotomy.