Long-term outcomes of minimally invasive concomitant mitral and tricuspid valve surgery with surgical ablation

Abstract

Objectives We compared outcomes of right mini-thoracotomy versus sternotomy for concomitant mitral and tricuspid valve surgery and surgical ablation.
Methods We analyzed patients who underwent concomitant mitral and tricuspid valve surgery and surgical ablation at single institution (Mean follow-up: 7 years) after propensity score matching. The primary and secondary outcomes were all-cause death, composite major adverse events (including stroke, reoperation, readmission, permanent pacemaker insertion) and atrial fibrillation recurrence. Subgroup analysis was performed.
Results 797 procedures (mean age: 61.6, right mini-thoracotomy: 45.2%, female: 66.5%, mitral valve repair: 33.6%), 267 pairs were matched. The 5 and 10-year overall survival in matched cohort was 92.7%, 86.9% for right mini-thoracotomy group, and 92.1% and 83.1% for sternotomy group (p = 0.879). Significant differences weren’t observed in major adverse events (p = 0.273, hazard ratio: 0.76) and atrial fibrillation recurrence (p = 0.080, hazard ratio: 0.72). Right mini-thoracotomy group had lower rates of post-operative low cardiac output syndrome (p = 0.019) and acute renal failure (p = 0.003). Atrial fibrillation high-risk factor (including long-standing atrial fibrillation, enlarged left atrium, old age) exhibited significant interactions (p for interaction = 0.002) with the approach regarding atrial fibrillation recurrence.
Conclusions In this study, right mini-thoracotomy exhibited no significant differences in long-term outcomes compared to sternotomy, but it could remain a clinically reasonable option. Patients with atrial fibrillation high-risk factor may have favourable ablation outcomes with sternotomy.

Keywords: Minimally invasive cardiac surgery, Surgical ablation, Long-term outcome