Analysis of clinical outcome and postoperative organ function effects in
a propensity-matched comparison between conventional and minimally
invasive mitral valve surgery
Abstract
Background: Minimally invasive mitral valve(MV) surgery(MIVT) is
increasingly performed with excellent clinical outcome, despite longer
procedural times. This study analyzes clinical outcome and secondary
organ function effects in a propensity-matched comparison with
conventional MV surgery. Methods and Results: Out of 439 patients
undergoing MV surgery from January 2005 to May 2017, 345 patients were
included after propensity-matching: 95 sternotomy patients and 250 MIVT
patients. Endpoints focused on survival, quality of MV repair and organ
function effects through analysis of biomarkers and functional
parameters. Despite longer cardiopulmonary bypass(sternotomy:
96.0(IQR34)min – MIVT:134.0(IQR42)min, p<0.001) and
cardioplegic arrest times(sternotomy: 61.0(IQR26)min –
MIVT:87.0(IQR34)min, p<0.001), no differences in survival nor
complication rate were found. Effect on renal function(creatinine,
p=0.751 – ureum, p=0.538 - glomerular filtration, p=0.848), myocardial
damage by troponine I level (sternotomy:1.8±3.9ng/ml –
MIVT:1.2±1.3ng/ml, p=0.438) and ventilatory support > 24
hours(sternotomy:5.5% - MIVT:9.5%, p=0.240) were comparable. Systemic
inflammatory reaction by postoperative CRP count was markedly lower for
MIVT(p<0.001). Increased rhadomyolysis was found after MIVT
surgery, based on significant elevation of creatinine-kinase
levels(sternotomy: 431±237U/L – MIVT: 701±595U/L, p<0.001).
Conclusion: Despite an inherent learning curve, minimally invasive MV
surgery guarantees a clinical outcome and MV repair quality, at least
non-inferior to those of MV surgery via sternotomy. Notwithstanding
longer cardiopulmonary bypass and cardiac arrest times, the impact on
secondary organ function is negligible, excepted for a lower systemic
inflammatory response. The postoperative increase of CK-enzymes
suggestive for enhanced rhabdomyolysis needs to be accounted when
procedural times tend to exceed the critical time threshold for severe
limb ischemia.