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Analysis of clinical outcome and postoperative organ function effects in a propensity-matched comparison between conventional and minimally invasive mitral valve surgery
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  • Sophie Missault,
  • Jerome Van Causenbroeck,
  • Korneel Vandewiele,
  • Jens Czapla,
  • Tine Philipsen,
  • Katrien François,
  • Thierry Bove
Sophie Missault
University Hospital Ghent
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Jerome Van Causenbroeck
University Hospital Ghent
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Korneel Vandewiele
University Hospital Ghent
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Jens Czapla
University Hospital Ghent
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Tine Philipsen
University Hospital Ghent
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Katrien François
University of Ghent
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Thierry Bove
University Hopsital of Ghent
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Abstract

Background: Minimally invasive mitral valve(MV) surgery(MIVT) is increasingly performed with excellent clinical outcome, despite longer procedural times. This study analyzes clinical outcome and secondary organ function effects in a propensity-matched comparison with conventional MV surgery. Methods and Results: Out of 439 patients undergoing MV surgery from January 2005 to May 2017, 345 patients were included after propensity-matching: 95 sternotomy patients and 250 MIVT patients. Endpoints focused on survival, quality of MV repair and organ function effects through analysis of biomarkers and functional parameters. Despite longer cardiopulmonary bypass(sternotomy: 96.0(IQR34)min – MIVT:134.0(IQR42)min, p<0.001) and cardioplegic arrest times(sternotomy: 61.0(IQR26)min – MIVT:87.0(IQR34)min, p<0.001), no differences in survival nor complication rate were found. Effect on renal function(creatinine, p=0.751 – ureum, p=0.538 - glomerular filtration, p=0.848), myocardial damage by troponine I level (sternotomy:1.8±3.9ng/ml – MIVT:1.2±1.3ng/ml, p=0.438) and ventilatory support > 24 hours(sternotomy:5.5% - MIVT:9.5%, p=0.240) were comparable. Systemic inflammatory reaction by postoperative CRP count was markedly lower for MIVT(p<0.001). Increased rhadomyolysis was found after MIVT surgery, based on significant elevation of creatinine-kinase levels(sternotomy: 431±237U/L – MIVT: 701±595U/L, p<0.001). Conclusion: Despite an inherent learning curve, minimally invasive MV surgery guarantees a clinical outcome and MV repair quality, at least non-inferior to those of MV surgery via sternotomy. Notwithstanding longer cardiopulmonary bypass and cardiac arrest times, the impact on secondary organ function is negligible, excepted for a lower systemic inflammatory response. The postoperative increase of CK-enzymes suggestive for enhanced rhabdomyolysis needs to be accounted when procedural times tend to exceed the critical time threshold for severe limb ischemia.

Peer review status:ACCEPTED

24 Jul 2020Submitted to Journal of Cardiac Surgery
24 Jul 2020Submission Checks Completed
24 Jul 2020Assigned to Editor
25 Jul 2020Reviewer(s) Assigned
11 Aug 2020Review(s) Completed, Editorial Evaluation Pending
11 Aug 2020Editorial Decision: Revise Major
17 Aug 20201st Revision Received
18 Aug 2020Submission Checks Completed
18 Aug 2020Assigned to Editor
20 Aug 2020Reviewer(s) Assigned
24 Aug 2020Review(s) Completed, Editorial Evaluation Pending
27 Aug 2020Editorial Decision: Accept