Minimally invasive mitral valve repair safe, effective vs. sternotomy
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Key takeaways:
- A minimally invasive approach to mitral valve repair was safe and effective vs. sternotomy.
- Recovery time and hospital stay were shorter in the minimally invasive group.
NEW ORLEANS — Minimally invasive thoracoscopically guided right mini-thoracotomy for mitral valve repair was as effective and safe compared with sternotomy, with faster recovery and shorter hospital stay, a speaker reported.
The results of the UK Mini Mitral trial were presented at the American College of Cardiology Scientific Session
Image: Adobe Stock
“The best approach for mitral valve repair is widely debated. Patients often prefer a minimally invasive approach because they’ll perceive it as smaller surgical insult and that they will recover quicker after surgery,” Enoch Akowuah, MD, professor and honorary clinical senior lecturer at Newcastle University in England, said during a presentation. “However, there are significant question marks about these approaches and it’s centered around the issue of clinical efficacy and safety.”
For this expertise-based superiority trial, Akowuah and colleagues used the SF-36v2 physical functioning questionnaire to assess physical function and return to usual activities at 12 weeks after minimally invasive thoracoscopically guided right mini-thoracotomy for mitral valve repair compared with sternotomy.
A total of 330 patients were enrolled and randomly assigned to the minimally invasive procedure or sternotomy (mean age, 67 years; 30% women). Twenty-eight surgeons across 10 sites in the U.K. were approved participate in the trial.
Baseline physical function as measured by SF-36v2 was approximately similar between the two groups (22.1% with low; 35.6% with medium; 42.3% with high) and 92% had severe mitral regurgitation.
Mitral valve repair via sternotomy was on average 44 minutes faster compared with the minimally invasive procedure.
At 6 weeks, the researchers observed significant improvement in physical function in the minimally invasive arm, whereas improvement was not observed until 12 weeks in the sternotomy arm; however, physical function continued to improve throughout 1 year in both groups.
Akowuah and colleagues reported that difference in change in physical function from baseline to 12 weeks between patients who underwent minimally invasive mitral valve repair and those who underwent sternotomy was not significant (mean difference in T-score, 0.675; 95% CI, –1.89 to 3.26; P = .61).
The researchers observed that mitral regurgitation severity was reduced to none or mild for 95% of participants in both study arms at 12 weeks and for 92% at 52 weeks, according to the presentation.
Likelihood of early adverse outcomes were similarly low between the two groups.
Median hospital stay was shorter in the minimally invasive arm (5 vs. 6 days; P = .003) and a greater proportion of participants were discharged within 4 days after surgery compared with the sternotomy group (33.1% vs. 15.3%; OR = 2.81; 95% CI, 1.6-4.94; P < .001).
In addition, days alive and out of hospital were higher at 30 days (mean difference, 1.05; 95% CI, 1.01-1.11) and 90 days (mean difference, 1.03; 95% CI, 1-1.05) in the minimally invasive surgery arm compared with sternotomy (P for both = .03).
Akowuah and colleagues observed no significant between-group differences in death, repeat operation or HF hospitalization at 1 year.
“This is the first and the largest multicenter [randomized controlled trial] comparing these two techniques. The expertise-based randomization to account for the learning curve was successfully performed. The difference in the change in physical function score from baseline to 12 weeks between groups was not significant,” Akowuah said. “However, physical function improved from baseline to 6 weeks in mini patients, but not in sternotomy patients. Time spent in moderate and vigorous physical activity and sleep efficiency was significant greater for mini patients. There’s a reduced length of stay and an increased likelihood of early discharge after minimally invasive surgery and quality of life favored mini at all time points measured.”
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Akowuah E, et al. Joint American College of Cardiology/New England Journal of Medicine Late-Breaking Clinical Trials. Presented at: American College of Cardiology Scientific Session; March 4-6, 2023; New Orleans (hybrid meeting).
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