Long-term outcomes of a totally thoracoscopic approach for reoperative mitral valve replacement: a propensity score matched analysis

Abstract

Background: This study aimed to summarize the perioperative and long-term outcomes of patients with previous mitral valve surgery (MVS) undergoing reoperative mitral valve replacement (MVR). Methods: Data for all reoperative mitral valve replacements (re-MVRs) with or without concomitant tricuspid surgery were analyzed from Guangdong Provincial People's Hospital between January 2013 and December 2019. Propensity score matching resulted in 30 matched pairs with improved balance after matching in baseline covariates. Perioperative data and long-term clinical outcomes were analyzed.Results: Results are based on the matched cohorts between the two groups. The in-hospital mortality was 3.3% (two deaths) in the entire cohort and was not significantly different between the median sternotomy (MS) group and the totally thoracoscopic (TT) group. Most patients in the TT group had their tracheal intubation removed within 24 hours of surgery. The TT group had a diminished requirement for blood transfusion and a reduced 4-day postoperative chest tube drainage amount. The incidence of early major complications, including all-cause death and reoperation due to bleeding, was lower in the TT group. No significant differences were observed in the 7-year survival probability between the two groups. Conclusions:The encouraging results regarding the perioperative and long-term outcomes of patients who underwent a TT re-MVR show that this approach is particularly beneficial for patients requiring reoperation.

Innovations and Developments in Totally Thoracoscopic Cardiac Procedures

“…Likewise, mitral valvuloplasty via TTCS is superior to those via median sternotomy in terms of the rate of blood transfusion, and the incidence of sternal and wound complications [40]. Although there was no survival difference at 7-year follow-up, it has been demonstrated that the perioperative outcomes including tracheal intubation, chest tube drainage, and transfusion in the patients who underwent re-operative mitral valve replacement via TTCS is improved [41]. A re-do mitral valve procedure following TTCS is safer since there are less retrosternal adhesions [42].…”

The anesthesia management of totally thoracoscopic cardiac surgery: A single-center retrospective study

“…In recent years, totally thoracoscopic cardiac surgery (TTCS) has been used for coronary artery bypass grafting, resection of cardiac myxoma [ 1 ], valve replacement [ 2 ], atrial septal defect (ASD) and ventricular septal defect (VSD) closure [ 3 , 4 ] ( Fig. 1 ).…”