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Cardiac surgery
Original research
Minimally invasive mitral valve surgery: a systematic safety analysis
  1. Kinsing Ko1,
  2. Thom L de Kroon1,
  3. Marco C Post2,3,
  4. Johannes C Kelder2,
  5. Karen F Schut4,
  6. Nabil Saouti1 and
  7. Bart P van Putte1,4
  1. 1Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
  2. 2Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
  3. 3Cardiology, UMC Utrecht, Utrecht, The Netherlands
  4. 4Cardiothoracic Surgery, Amsterdam UMC, Amsterdam, The Netherlands
  1. Correspondence to Mr Kinsing Ko; kinsingko{at}gmail.com

Abstract

Objective Minimally invasive surgery is increasingly adopted as an alternative to conventional sternotomy for mitral valve pathology in many centres worldwide. A systematic safety analysis based on a comprehensive list of pre-specified 30-day complications defined by the Mitral Valve Academic Consortium (MVARC) criteria is lacking. The aim of the current study was to systematically analyse the safety of minimally invasive mitral valve surgery in our centre based on the MVARC definitions.

Methods All consecutive patients undergoing minimally invasive mitral valve surgery through right mini-thoracotomy in our institution within 10 years were studied retrospectively. The primary outcome was a composite of 30-day major complications based on MVARC definitions.

Results 745 patients underwent minimally invasive mitral valve surgery (507 repair, 238 replacement), with a mean age of 62.9±12.3 years. The repair was successful in 95.8%. Overall 30-day mortality was 1.2% and stroke rate 0.3%. Freedom from any 30-day major complications was 87.2%, and independent predictors were left ventricular ejection fraction <50% (OR 1.78; 95% CI 1.02 to 3.02) and estimated glomerular filtration rate <60 mL/min/1.73 m2 (OR 1.98; 95% CI 1.17 to 3.26).

Conclusions Minimally invasive mitral valve surgery is a safe technique and is associated with low 30-day mortality and stroke rate.

  • minimally invasive mitral valve surgery
  • safety analysis
  • predictors for complications
  • MVARC
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2020-001393

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    Footnotes

    • KK and TLdK contributed equally.

    • NS and BPvP contributed equally.

    • Contributors All listed authors contributed substantial to the work, approved the final version and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. KK and TLdK contributed equally to this work. BPvP and NS contributed equally to this work. KK: drafting of the work and writing of manuscript. Acquisition, analysis and interpretation of data. TLdK: conceptualisation and critical revision of the work. KFS: acquisition of data and critical revision of the work. JCK: analysis of data and critical revision of the work. NS: conceptualisation and critical revision of the work. BPvP: conceptualisation and critical revision of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethical approval information Ethical approval for this study was waived by the ethical committee of St. Antonius Hospital (reference number W18.161) due to retrospective design of this study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.