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JAMA Jun 2023The safety and effectiveness of mitral valve repair via thoracoscopically-guided minithoracotomy (minithoracotomy) compared with median sternotomy (sternotomy) in... (Comparative Study)
Comparative Study Randomized Controlled Trial
IMPORTANCE
The safety and effectiveness of mitral valve repair via thoracoscopically-guided minithoracotomy (minithoracotomy) compared with median sternotomy (sternotomy) in patients with degenerative mitral valve regurgitation is uncertain.
OBJECTIVE
To compare the safety and effectiveness of minithoracotomy vs sternotomy mitral valve repair in a randomized trial.
DESIGN, SETTING, AND PARTICIPANTS
A pragmatic, multicenter, superiority, randomized clinical trial in 10 tertiary care institutions in the UK. Participants were adults with degenerative mitral regurgitation undergoing mitral valve repair surgery.
INTERVENTIONS
Participants were randomized 1:1 with concealed allocation to receive either minithoracotomy or sternotomy mitral valve repair performed by an expert surgeon.
MAIN OUTCOMES AND MEASURES
The primary outcome was physical functioning and associated return to usual activities measured by change from baseline in the 36-Item Short Form Health Survey (SF-36) version 2 physical functioning scale 12 weeks after the index surgery, assessed by an independent researcher masked to the intervention. Secondary outcomes included recurrent mitral regurgitation grade, physical activity, and quality of life. The prespecified safety outcomes included death, repeat mitral valve surgery, or heart failure hospitalization up to 1 year.
RESULTS
Between November 2016 and January 2021, 330 participants were randomized (mean age, 67 years, 100 female [30%]); 166 were allocated to minithoracotomy and 164 allocated to sternotomy, of whom 309 underwent surgery and 294 reported the primary outcome. At 12 weeks, the mean between-group difference in the change in the SF-36 physical function T score was 0.68 (95% CI, -1.89 to 3.26). Valve repair rates (≈ 96%) were similar in both groups. Echocardiography demonstrated mitral regurgitation severity as none or mild for 92% of participants at 1 year with no difference between groups. The composite safety outcome occurred in 5.4% (9 of 166) of patients undergoing minithoracotomy and 6.1% (10 of 163) undergoing sternotomy at 1 year.
CONCLUSIONS AND RELEVANCE
Minithoracotomy is not superior to sternotomy in recovery of physical function at 12 weeks. Minithoracotomy achieves high rates and quality of valve repair and has similar safety outcomes at 1 year to sternotomy. The results provide evidence to inform shared decision-making and treatment guidelines.
TRIAL REGISTRATION
isrctn.org Identifier: ISRCTN13930454.
Topics: Aged; Female; Humans; Cardiac Surgical Procedures; Mitral Valve; Mitral Valve Insufficiency; Quality of Life; Sternotomy; Thoracotomy; Treatment Outcome; Thoracoscopy; Male; Recovery of Function
PubMed: 37314276
DOI: 10.1001/jama.2023.7800 -
CASE (Philadelphia, Pa.) Mar 2024• Transseptal MV implantation is performed for many indications. • Previous ViV procedures do not preclude further ViV insertion. • Appropriate sizing of...
• Transseptal MV implantation is performed for many indications. • Previous ViV procedures do not preclude further ViV insertion. • Appropriate sizing of transseptal MVs is essential to reduce complications. • Multimodality cardiac imaging is essential for valve placement and follow-up. • Frequent serial TTE is recommended for follow-up.
PubMed: 38524886
DOI: 10.1016/j.case.2023.12.031 -
Frontiers in Cardiovascular Medicine 2023Totally endoscopic robotic mitral valve repair is the least invasive surgical therapy for mitral valve disease. Robotic mitral valve surgery demonstrates faster recovery... (Review)
Review
Totally endoscopic robotic mitral valve repair is the least invasive surgical therapy for mitral valve disease. Robotic mitral valve surgery demonstrates faster recovery with shorter hospital stays, less morbidity, and equivalent mortality and mid-term durability compared to sternotomy. In this review, we will explore the advantages and disadvantages of robotic mitral valve surgery and consider important technical details of both operative set-up and mitral valve repair techniques. The number of robotic cardiac surgical procedures being performed globally is expected to continue to rise as experience grows with robotic techniques and increasing numbers of cardiac surgeons become proficient with this innovative technology. This will be facilitated by the introduction of newer robotic systems and increasing patient demand.
PubMed: 38505666
DOI: 10.3389/fcvm.2023.1239742