Innovations (Philadelphia, Pa.) · 2019
Operative Outcomes of Concomitant Minimally Invasive Mitral and Tricuspid Valve Surgery.
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Kilic Arman, Szeto Wilson Y, Atluri Pavan, Acker Michael A, Clark Hargrove W
Аннотация
OBJECTIVE: The aim of this study was to evaluate whether the addition of concomitant tricuspid valve surgery (TVS) negatively impacted operative outcomes of minimally invasive mitral valve surgery (MIMVS).
METHODS: Patients undergoing MIMVS via a port-access right minithoracotomy between 2002 and 2014 at a single institution were reviewed. Patients were primarily stratified by those undergoing isolated MIMVS versus MIMVS+TVS. Propensity-matched cohorts were generated. Operative outcomes were compared between the propensity-matched cohorts and included operative mortality, complications, and length of hospital stay.
RESULTS: A total of 1,158 patients underwent MIMVS via port-access right minithoracotomy. The majority of cases were elective (93%; n = 1,071) and 148 (13%) underwent concomitant MIMVS + TVS. Patients undergoing MIMVS + TVS were at higher risk at baseline. After propensity-matching, there were 119 isolated MIMVS and 119 MIMVS + TVS patients that were well matched with respect to all baseline variables. Cardiopulmonary bypass (148 ± 54 minutes versus 175 ± 54 minutes, P < 0.001) and aortic occlusion times (105 ± 36 minutes versus 128 ± 40 minutes, P < 0.001) were longer in the MIMVS + TVS group. Operative mortality was comparable (3% isolated MIMVS versus 4% for MIMVS + TVS; P = 0.73). Permanent pacemakers were required less frequently in the isolated MIMVS group (1% versus 6%; P = 0.03). All other complication rates were similar. Median length of hospital stay (7 versus 8 days; P = 0.13) and discharge-to-home rates (89% versus 94%; P = 0.15) were comparable.
CONCLUSIONS: Despite longer operative times, minimally invasive TVS performed concomitantly with MIMVS has similar operative outcomes with the exception of a higher pacemaker rate when compared with isolated MIMVS.
METHODS: Patients undergoing MIMVS via a port-access right minithoracotomy between 2002 and 2014 at a single institution were reviewed. Patients were primarily stratified by those undergoing isolated MIMVS versus MIMVS+TVS. Propensity-matched cohorts were generated. Operative outcomes were compared between the propensity-matched cohorts and included operative mortality, complications, and length of hospital stay.
RESULTS: A total of 1,158 patients underwent MIMVS via port-access right minithoracotomy. The majority of cases were elective (93%; n = 1,071) and 148 (13%) underwent concomitant MIMVS + TVS. Patients undergoing MIMVS + TVS were at higher risk at baseline. After propensity-matching, there were 119 isolated MIMVS and 119 MIMVS + TVS patients that were well matched with respect to all baseline variables. Cardiopulmonary bypass (148 ± 54 minutes versus 175 ± 54 minutes, P < 0.001) and aortic occlusion times (105 ± 36 minutes versus 128 ± 40 minutes, P < 0.001) were longer in the MIMVS + TVS group. Operative mortality was comparable (3% isolated MIMVS versus 4% for MIMVS + TVS; P = 0.73). Permanent pacemakers were required less frequently in the isolated MIMVS group (1% versus 6%; P = 0.03). All other complication rates were similar. Median length of hospital stay (7 versus 8 days; P = 0.13) and discharge-to-home rates (89% versus 94%; P = 0.15) were comparable.
CONCLUSIONS: Despite longer operative times, minimally invasive TVS performed concomitantly with MIMVS has similar operative outcomes with the exception of a higher pacemaker rate when compared with isolated MIMVS.