Propensity-matched analysis of minimally invasive mitral valve repair using a nationwide surgical database

Hiroyuki Nishi, Hiroaki Miyata, Noboru Motomura, Koichi Toda, Shigeru Miyagawa, Yoshiki Sawa, Shinichi Takamoto

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose: The aim of this study was to compare the cases of minimally invasive mitral valve surgery (MICS-mitral) performed using right mini-thoracotomy (RT) with those performed using median sternotomy (MS). Methods: Between 2008 and 2012, 6137 patients underwent isolated mitral valve repair at 210 institutions and were registered in the Japan Adult Cardiovascular Surgery Database. We compared 756 who underwent MICS-mitral via RT to 5381 MS patients and performed a one-to-one matched analysis based on the estimated propensity score. Results: The in-hospital mortality was similar between both groups (RT vs. MS: 0.5 vs. 1.1 %). Although the incidence of postoperative stroke, renal failure, and prolonged ventilation was similar, the number of patients with mediastinitis was greater in the MS group (RT vs. MS: 0 vs. 0.7 %, p < 0.01). Reexploration for bleeding was more frequent in the RT group (RT vs. MS: 2.9 vs. 1.4 %, p < 0.01). Mortality and morbidity occurred at a higher rate in low-volume institutions. The propensity analysis showed that the operation-related times were significantly longer in the RT group, while the length of hospital stay was shorter. In a propensity analysis of patients <60 years of age, there was no in-hospital mortality. Conclusions: MICS-mitral via RT was successful without compromising the clinical outcomes. Although the operation time and postoperative bleeding should be improved, an RT approach is safe in appropriately selected patients, especially those <60 years of age or treated in a high-volume center.

Original languageEnglish
Pages (from-to)1144-1152
Number of pages9
JournalSurgery Today
Volume45
Issue number9
DOIs
Publication statusPublished - 2015 Sep 17
Externally publishedYes

Fingerprint

Thoracotomy
Mitral Valve
Sternotomy
Databases
Hospital Mortality
Length of Stay
Mediastinitis
Propensity Score
Bleeding Time
Renal Insufficiency
Ventilation
Japan
Stroke
Hemorrhage
Morbidity
Mortality
Incidence

Keywords

  • Mitral valve
  • Surgery
  • Valvular diseases

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Propensity-matched analysis of minimally invasive mitral valve repair using a nationwide surgical database. / Nishi, Hiroyuki; Miyata, Hiroaki; Motomura, Noboru; Toda, Koichi; Miyagawa, Shigeru; Sawa, Yoshiki; Takamoto, Shinichi.

In: Surgery Today, Vol. 45, No. 9, 17.09.2015, p. 1144-1152.

Research output: Contribution to journalArticle

Nishi, Hiroyuki ; Miyata, Hiroaki ; Motomura, Noboru ; Toda, Koichi ; Miyagawa, Shigeru ; Sawa, Yoshiki ; Takamoto, Shinichi. / Propensity-matched analysis of minimally invasive mitral valve repair using a nationwide surgical database. In: Surgery Today. 2015 ; Vol. 45, No. 9. pp. 1144-1152.
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AU - Sawa, Yoshiki

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N2 - Purpose: The aim of this study was to compare the cases of minimally invasive mitral valve surgery (MICS-mitral) performed using right mini-thoracotomy (RT) with those performed using median sternotomy (MS). Methods: Between 2008 and 2012, 6137 patients underwent isolated mitral valve repair at 210 institutions and were registered in the Japan Adult Cardiovascular Surgery Database. We compared 756 who underwent MICS-mitral via RT to 5381 MS patients and performed a one-to-one matched analysis based on the estimated propensity score. Results: The in-hospital mortality was similar between both groups (RT vs. MS: 0.5 vs. 1.1 %). Although the incidence of postoperative stroke, renal failure, and prolonged ventilation was similar, the number of patients with mediastinitis was greater in the MS group (RT vs. MS: 0 vs. 0.7 %, p < 0.01). Reexploration for bleeding was more frequent in the RT group (RT vs. MS: 2.9 vs. 1.4 %, p < 0.01). Mortality and morbidity occurred at a higher rate in low-volume institutions. The propensity analysis showed that the operation-related times were significantly longer in the RT group, while the length of hospital stay was shorter. In a propensity analysis of patients <60 years of age, there was no in-hospital mortality. Conclusions: MICS-mitral via RT was successful without compromising the clinical outcomes. Although the operation time and postoperative bleeding should be improved, an RT approach is safe in appropriately selected patients, especially those <60 years of age or treated in a high-volume center.

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