Patients with degenerative mitral regurgitation, which requires surgery, may either opt for a standard procedure that requires a sternotomy. As an alternative, patients can safely choose a minimally invasive thoracotomy. This resulted in a randomized comparison of the two techniques.
The minimally invasive approach showed some advantages in the study. After 12 weeks, there were no significant differences in recovery.But patients in the group with minimally invasive thoracotomy fared significantly better after 6 weeks than patients in the group with conventional surgical techniques.
According to the British Mini-Mitral study, patients after minimally invasive procedures also spent significantly shorter hospital stays, and they spent fewer days under inpatient therapy in the following months. Neither method had any advantages in terms of postoperative clinical risk in the study. Rates of clinical events such as death or hospitalization for heart failure were about the same over 1 year.
This 1st randomised head-to-head comparison of the two procedures should make both patients and physicians more confident when it comes to opting for minimally invasive surgery, said Dr. Enoch Akowuah, Newcastle University, United Kingdom. He presented results of the mini-mitral study on March 5 at the American College of Cardiology () Scientific Session/World Congress of Cardiology (WCC) 2023 [1].
First comparative study of both procedures
The researchers assigned 330 patients in 10 centres in the UK to standard sternotomy or mini-thoracotomy surgery.The steering committee had previously selected 28 surgeons with relevant expertise.
The technically more sophisticated mini-thoracotomy lasted an average of 44 minutes longer, extended the cross-clamp time by eleven minutes and required 30 minutes more cardiopulmonary bypass support.
Both patient groups did not differ significantly in the primary endpoint, i.e. in physical function and in the ability to return to normal activity levels after 12 weeks. This was shown by results of the 36-Item Short Form Survey (SF-36) and the wrist-worn accelerometer. However, after 6 weeks, patients with mini-thoracotomy had an advantage. They felt better before.
Minimally invasive surgery: advantages in secondary endpoints
However, the mini-thoracotomy group performed significantly better on some secondary endpoints. The median length of hospital stay was 5 days versus 6 days in the sternotomy group (p=0.003), and 33.1% of patients with mini-thoracotomy were discharged within 4 days of surgery, compared to only 15.3% of patients who underwent the standard procedure (p<0.001).
Participants in the mini-thoracotomy group also spent slightly more time alive outside the hospital (p=0.03 for both analyses):
The safety results at 12 weeks were similar, with no significant differences in death, stroke, myocardial infarction or renal impairment, as well as no difference in length of stay in the intensive care unit or the need for more than 48 hours of mechanical ventilation.
The safety results after 1 year were also similar.Mortality at this time was 2.4% in the mini-thoracotomy group and 2.5% in the sternotomy group. There were also no significant differences in the rate of heart failure or the need for re-surgical intervention.
Akowuah said patients would continue to be followed for up to 5 years in terms of primary outcomes, changes in ECG and clinical events.
This entry appeared on Medscape.de. It was translated and adapted by Michael van den Heuvel from www.medscape.com .
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