Original articleAdult cardiacLess Invasive Mitral Surgery Versus Conventional Sternotomy Stratified by Mitral Pathology
Section snippets
Patient Population
Using the STS ACSD, we examined patients undergoing isolated primary mitral valve surgery via either limited (mini) thoracotomy, thoracoscopic- or port-assisted, or robotic-assisted approaches compared with those undergoing conventional sternotomy from 1 July 2014 to 31 December 2018. Partial sternotomy (eg, upper or lower hemisternotomy) was excluded from this analysis, as it is performed infrequently compared with other less invasive approaches for mitral surgery.14 Isolated mitral operations
Patient Population
From July 2014 to December 2018, 97,025 patients underwent mitral surgery. Of these, 55,943 were excluded based on criteria outlined above, yielding 41,082 patients undergoing primary isolated mitral valve surgery via either LIMS or sternotomy, included for propensity score-adjusted analysis (Figure 1). Annual total isolated primary mitral case volumes were relatively constant: 2014 (4331 [6 months]), 2015 (9343), 2016 (9234), 2017 (9768), and 2018 (8406). Patients were treated at 1054
Comment
Approximately 1 in 3 isolated mitral operations in North America is currently performed via a less invasive, sternal-sparing approach, generally in higher-volume settings, suggesting some degree of centralization at centers of excellence, as mitral valve operative volume has previously been correlated with improved outcomes.17,18
After propensity score adjustment, patients were well-balanced in terms of preoperative risk and mitral pathology. Overall, and specifically within both degenerative
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Circulation
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