Minimally invasive surgery versus sternotomy in native mitral valve endocarditis: a matched comparison

Abstract

Abstract   OBJECTIVES The present study compared the clinical outcomes between minimally invasive surgery (MIS) and median sternotomy (MS) in patients with native mitral valve infective endocarditis. METHODS From 2009 to 2019, a total of 154 patients with acute (n = 131, 85%) or subacute (n = 23, 15%) native mitral valve infective endocarditis were included in the study. One-to-one nearest neighbour propensity score matching considering endocarditis severity using the dedicated De Feo score and 19 other clinically relevant baseline variables resulted in a population of 39 matched pairs. The matched cohort was investigated regarding operative and postoperative outcomes. RESULTS Both groups showed similar results regarding cardiopulmonary bypass time [MIS: 96 min (77–138), MS: 99 min (88–127); P = 0.780] and aortic cross-clamp time [MIS: 64 min (54–90), MS: 65 min (59–83); P = 0.563], whereas overall operative time was shorter through minimally invasive access [MIS: 138 min (112–196), MS: 187 min (175–230); P = 0.005]. Although the rate of revision for bleeding was similar in both groups [MIS: 12.8% (n = 5), MS: 10.3% (n = 4); P = 1.000], MIS was associated with fewer red blood cell unit transfusions [MIS: 1 unit (0–4), MS: 4 units (2–10); P = 0.001] and fewer fresh frozen plasma unit transfusions [MIS: 0 units (0–0), MS: 1 unit (0–5); P = 0.002]. MIS was associated with a shorter ventilation time [MIS: 708 min (429–1236), MS: 1440 min (659–4411); P = 0.024] and a lower rate of reintubation after extubation [MIS: 5.1% (n = 2), MS: 25.6% (n = 10); P = 0.021]. CONCLUSIONS In patients suffering from native mitral valve infective endocarditis, MIS provides significant clinical benefits over sternotomy in selected patients. Subject collection 117, 121.