Echocardiographic assessment of mitral durability in the late period following mitral valve repair: Minithoracotomy versus conventional sternotomy

Abstract

Objective: To compare the long-term echocardiographic mitral valve (MV) durability after MV repair performed through a minithoracotomy versus conventional sternotomy. Methods: A total of 299 patients who underwent MV repair for degenerative mitral regurgitation (MR) through minithoracotomy (n = 179) or sternotomy (n = 120), between April 2004 and January 2010, were evaluated. To adjust the differences in baseline characteristics between the 2 groups, weighted Cox proportional-hazards regression models and inverse-probability-of-treatment weighting were used. Results: There were no 30-day deaths in both groups and no significant differences in early complication rates. Clinical follow-up was complete in 294 patients (98.3%), with a median follow-up of 55.4 months (interquartile range, 34.4-66.9 months), during which there were 10 late deaths, 2 strokes, and 3 reoperations for recurrent MR. After adjustment, the minithoracotomy group had similar risks for major adverse cardiac events (hazard ratio, 0.77; 95% confidence interval, 0.22-2.68; P =.68). Echocardiographic evaluation in the late period (>6 months) was possible in 292 patients (97.7%), with a median follow-up of 29.4 months (interquartile range, 13.3-49.7 months), during which 21 patients (12 in the minithoracotomy group and 9 in the sternotomy group) experienced significant MR (>2+). Freedom from significant MR at 5 years was 86.1% ± 4.8% versus 85.3% ± 5.5% (P =.63). After adjustment, the minithoracotomy group had similar risks for significant MR (hazard ratio, 0.81; 95% confidence interval, 0.31-2.14; P =.67). Conclusions: A minithoracotomy approach for MV repair showed comparable clinical outcomes and efficacy to conventional sternotomy for MV repair. Crown Copyright © 2014 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery.