Our Summary

This paper studied the outcomes of patients who underwent mitral valve surgery (a heart surgery) using two different methods - the traditional method (through a large incision in the chest) and a newer, minimally invasive method (through a small incision). The study was conducted between January 2012 and May 2019 on 605 patients. The researchers used a method called ‘propensity score matching’ to make sure that the patients in both groups were similar, reducing bias in the results.

The results showed that while the minimally invasive method took a bit longer, it had several advantages. It was associated with fewer cases of having to return to surgery due to bleeding, less need for blood transfusions, and a shorter stay in the hospital. The death rate within 30 days of surgery was low for both methods.

In conclusion, the minimally invasive method for mitral valve surgery had similar short-term outcomes as the traditional method, without increasing the risk of problems. The study also suggests that such minimally invasive surgeries can be successfully implemented with a small team of surgeons and a well-planned strategy.

FAQs

  1. What were the two methods of mitral valve surgery studied in this research?
  2. What advantages did the minimally invasive method show in comparison to the traditional method of surgery?
  3. Did the minimally invasive method of surgery increase the risk of problems compared to the traditional method?

Doctor’s Tip

A doctor might tell a patient about sternotomy, the traditional method of chest incision for heart surgery, that there are newer, minimally invasive methods available that can result in fewer complications, less need for blood transfusions, and a shorter hospital stay. It is important for patients to discuss all options with their healthcare provider to determine the best approach for their specific case.

Suitable For

Patients who are typically recommended sternotomy for mitral valve surgery include those with severe mitral valve disease, such as mitral regurgitation or mitral stenosis, who have failed conservative management or have significant symptoms. Additionally, patients who have other coexisting heart conditions that require simultaneous surgical intervention may also be recommended sternotomy. Ultimately, the decision on the type of surgery to be performed should be made on a case-by-case basis after a thorough evaluation by a cardiac surgeon.

Timeline

Timeline of a patient’s experience before and after sternotomy:

Before sternotomy:

  • Patient undergoes preoperative testing and evaluation to determine the need for surgery and assess any risks.
  • Patient meets with the surgical team to discuss the procedure, risks, and recovery process.
  • Patient may undergo additional tests, such as blood tests, imaging studies, and cardiac catheterization.
  • Patient is instructed on preoperative preparations, such as fasting before surgery and stopping certain medications.
  • Patient may be admitted to the hospital the day before surgery for further preparation.

After sternotomy:

  • Patient is taken to the operating room and undergoes general anesthesia.
  • Surgeon performs the sternotomy, which involves cutting through the breastbone to access the heart.
  • Surgery is performed to repair or replace the heart valve, in this case, the mitral valve.
  • Patient is monitored closely in the intensive care unit (ICU) immediately after surgery.
  • Patient may experience pain, fatigue, and difficulty breathing in the immediate postoperative period.
  • Patient is gradually weaned off of mechanical ventilation and other support devices.
  • Patient begins physical therapy and rehabilitation to regain strength and function.
  • Patient is discharged from the hospital once stable and able to care for themselves at home.
  • Patient undergoes follow-up appointments with the surgical team to monitor recovery and address any concerns.

What to Ask Your Doctor

  1. What is sternotomy and why is it used in mitral valve surgery?

  2. What are the potential risks and complications associated with sternotomy?

  3. How does the traditional method of mitral valve surgery (through a large incision) compare to the minimally invasive method (through a small incision)?

  4. What are the advantages of the minimally invasive method compared to the traditional method?

  5. How long is the recovery time for each method of surgery?

  6. Will I have a scar after undergoing sternotomy? If so, how noticeable will it be?

  7. How experienced is the surgical team in performing minimally invasive mitral valve surgery?

  8. What are the long-term outcomes associated with each method of surgery?

  9. Are there any specific lifestyle changes or precautions I should take after undergoing sternotomy?

  10. Are there any alternative treatment options to sternotomy for mitral valve surgery?

Reference

Authors: Kastengren M, Svenarud P, Källner G, Franco-Cereceda A, Liska J, Gran I, Dalén M. Journal: Eur J Cardiothorac Surg. 2020 Dec 1;58(6):1168-1174. doi: 10.1093/ejcts/ezaa232. PMID: 32920639