Host response to mitral valve surgery: full sternotomy versus minithoracotomy

OBJECTIVE – Minimal invasive mitral valve repair has become standard of care. It is a safe and durable alternative to conventional median sternotomy, resulting in less pain and faster recovery. The factors contributing to these advantages remain poorly understood. We studied the biological effects of full sternotomy compared to minithoracotomy for mitral valve surgery. METHODS – Single centre data from patients who underwent mitral valve surgery were retrospectively collected. Patients were divided in two groups based upon type of surgery: Full Sternotomy or Port-Access. Propensity score matching, based upon age, gender, BSA, NYHA, preoperative rhythm, and medical history was performed. Perioperative characteristics, including biochemical data of the first 10 days postoperatively (Haemoglobin, Haematocrit, Red blood cell count, Plateled count, White blood cell count, C-reactive protein, Creatinine, and Troponine) were collected for analysis. RESULTS – Each group of the matched cohort consisted of 126 patients. Port-Access was associated with significant longer cardiopulmonary bypass times, longer aortic cross-clamp times, shorter hospital and intensive care stay. The amount of blood transfused, and inotropic agents and vasopressors administered were lower in Port-Access. Analysis of biochemical characteristics show a faster recovery of blood cell counts, lower CRP levels and less increase in troponin levels after Port-Access surgery. CONCLUSIONS – Port-access mitral valve surgery, though associated with longer cardio-pulmonary bypass and cross-clamp times, results in faster haematological recovery, less inflammatory response, and less myocardial damage. These factors may contribute to the faster recovery after minimal invasive mitral valve surgery.status: publishe