Purpose: Multiple studies have reported worse outcomes with mitral valve replacement (MVR) in comparison to mitral repair (MVRe). We aimed to compare outcomes of MVRe and MVR utilizing a minimally invasive approach via a right-thoracotomy. Methods: From 2019-23, 1,020 patients underwent mitral valve surgery, among these 952 underwent minimally invasive surgery. After excluding patients with prior mitral replacement , an inverse probability matching (IPW) for baseline characteristics (such as age, heart failure, previous surgery, and concomitant procedures) was utilized. Each patient was weighted and IPW final cohort represented 1,810 weighted observations (MVR=870, MVRe=940). Survey-based comparisons for weighted observations and weighted logistic regression models were used to assess significant differences. Results: The median age of the matched cohort was 67 years (IQR-59-76) and 54% were female; neither factor differed between MVRe and MVR groups. There was a similar ratio of isolated surgery between the groups (52% vs 48%, p>0.9), but a significant increase in cross-clamp (84 vs 77 min, p=0.015) and bypass (114 vs 108 min, p=0.029) times in MVRe compared to MVR. The outcomes were not different in terms of mortality (1.1%[n=10] vs 2.0% [n=17], p=0.4) or postoperative stroke (0.2%[n=1] vs 1.0% [n=9], p=0.076) in MVRe and MVR, respectively. However, MVRe had lower transfusion requirements (18% vs 35%, p< 0.001), total ventilation time (3 hours [2-5] vs 4 [2-7], p= 0.004), and hospital length of stay (4 days [3-5] vs 5 [4-7], p< 0.001). Factors significantly associated with mortality were heart failure (NYHA 3 or 4, OR=14, p< 0.001), anemia (OR=10.6, p< 0.001), and creatinine>2 mg/dL (OR=8.14, p=0.007). Conclusion: Contrary to other studies, there was no significant difference in mortality, stroke, or rehospitalization over 30 days between MVRe and MVR. Amongst both groups, heart failure, anemia, and kidney dysfunction were identified as risk factors for increasing in-hospital mortality. Thus, special consideration to optimize patients with anemia and renal dysfunction is warranted in order to improve post operative outcomes.
Identify the source of the funding for this research project: NA
