Right Minithoracotomy Versus Median Sternotomy for Mitral Valve Surgery: A Propensity Matched Study.

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2015-08

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Abstract

Background

The efficacy of conventional median sternotomy versus a right minithoracotomy (RT) approach to mitral valve surgery was evaluated in a single high-volume institution.

Methods

A retrospective analysis of a single institution's experience was performed using propensity matching of 1,694 patients who underwent mitral valve surgery during a 15-year period. Patients who had procedures that were not usually performed through an RT approach were excluded. Using 1:1 propensity score matching, we obtained 215 matched patients in each group for outcomes analysis.

Results

There was no difference in the median year of operation between the two groups (2002 versus 2001; p = 0.142). The RT approach was not a predictor of postoperative mortality. Predictors of mortality included increasing age, diabetes, smoking, preoperative dialysis, lung disease, advanced congestive heart failure class, and peripheral vascular disease. The RT approach was associated with less new-onset atrial fibrillation (8% versus 16%; p = 0.018), pneumonia (1% versus 5%; p = 0.049), respiratory failure (3% versus 8%; p = 0.036), and acute renal failure (2% versus 7%; p = 0.006), lower chest tube output (350 versus 840 mL; p < 0.001), and fewer red blood transfusions (2 versus 3 units; p = 0.001).

Conclusions

Right minithoracotomy compared with median sternotomy for mitral valve surgery was associated with less postoperative atrial fibrillation, respiratory complications, acute renal failure, chest tube output, and use of packed red blood cells. Given study limitations, the RT approach for mitral valve surgery may have advantages over median sternotomy in selected patients.

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Published Version (Please cite this version)

10.1016/j.athoracsur.2015.04.027

Publication Info

Tang, Paul, Mark Onaitis, Jeffrey G Gaca, Carmelo A Milano, Mark Stafford-Smith and Donald Glower (2015). Right Minithoracotomy Versus Median Sternotomy for Mitral Valve Surgery: A Propensity Matched Study. The Annals of thoracic surgery, 100(2). pp. 575–581. 10.1016/j.athoracsur.2015.04.027 Retrieved from https://hdl.handle.net/10161/22847.

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Scholars@Duke

Onaitis

Mark William Onaitis

Adjunct Associate Professor in the Department of Surgery

Mouse Models of Foregut Malignancies
Normal Tissue and Cancer Stem Cells
Risk Prediction in Thoracic Malignancies

Gaca

Jeffrey Giles Gaca

Associate Professor of Surgery
Milano

Carmelo Alessio Milano

Joseph W. and Dorothy W. Beard Distinguished Professor of Experimental Surgery

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