An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery
Background: For mitral valve surgery (MVS) in elderly, frail patients with increasing life expectancy, finding the least harmful means of access is a challenge. In the complexity of MVS approach evolution, using three different approaches (mini-thoracotomy (MT), partial upper-sternotomy (PS), full-s...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-01-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/10/1/28 |
| _version_ | 1827624642788982784 |
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| author | Ulvi Cenk Oezpeker Fabian Barbieri Daniel Höfer Can Gollmann-Tepeköylü Johannes Holfeld Florian Sommerauer Julian Wagner Sasa Rajsic Suat Ersahin Nikolaos Bonaros Michael Grimm Müller Ludwig |
| author_facet | Ulvi Cenk Oezpeker Fabian Barbieri Daniel Höfer Can Gollmann-Tepeköylü Johannes Holfeld Florian Sommerauer Julian Wagner Sasa Rajsic Suat Ersahin Nikolaos Bonaros Michael Grimm Müller Ludwig |
| author_sort | Ulvi Cenk Oezpeker |
| collection | DOAJ |
| description | Background: For mitral valve surgery (MVS) in elderly, frail patients with increasing life expectancy, finding the least harmful means of access is a challenge. In the complexity of MVS approach evolution, using three different approaches (mini-thoracotomy (MT), partial upper-sternotomy (PS), full-sternotomy (FS), we developed a personalized, minimized-invasiveness algorithm for MVS. Methods: In this retrospective analysis, 517 elderly patients (≥70 years) were identified who had undergone MVS ± TV repair. MVS was performed via MT (<i>n</i> = 274), FS (<i>n</i> = 128) and PS (<i>n</i> = 115). The appropriate access type was defined according to several clinical patient conditions. Using uni- and multivariate regression models, we analyzed combined operative success (residual MV regurgitation, conversion to MV replacement or larger thoracic incisions); perioperative success (30-days mortality, thoracotomy, ECMO, pacemaker implantation, dialysis, longer ventilation); and reoperation-free long-term survival. An additional EuroSCORE2 adjustment was performed to reduce the bias of clinical conditions between all access types. Results: The EuroSCORE2-adjusted Cox regression analysis showed significantly increased reoperation-free survival in the MT cohort compared to FS (HR 0.640; 95% CI 0.442–0.926; <i>p</i> = 0.018). Mortality was additionally reduced after the implementation of PS (<i>p</i> = 0.023). Combined operative success was comparable between the three access types. The perioperative success was higher in the MT cohort compared to FS (OR 2.19, 95% CI 1.32–3.63; <i>p</i> = 0.002). Conclusion: Less-invasive approaches in elderly patients improve perioperative success and reoperation-free survival in those undergoing MVS procedures. |
| first_indexed | 2024-03-09T12:13:38Z |
| format | Article |
| id | doaj.art-32e19994e75a48db9d24b4d0abe7d273 |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-09T12:13:38Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-32e19994e75a48db9d24b4d0abe7d2732023-11-30T22:49:20ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252023-01-011012810.3390/jcdd10010028An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve SurgeryUlvi Cenk Oezpeker0Fabian Barbieri1Daniel Höfer2Can Gollmann-Tepeköylü3Johannes Holfeld4Florian Sommerauer5Julian Wagner6Sasa Rajsic7Suat Ersahin8Nikolaos Bonaros9Michael Grimm10Müller Ludwig11Department of Cardiac Surgery, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Cardiology, Charité—Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, GermanyDepartment of Cardiac Surgery, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Cardiac Surgery, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Cardiac Surgery, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Cardiac Surgery, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, AustriaSakarya Eğitim ve Araştırma Hospital, 54100 Adapazarı, TurkeyDepartment of Cardiac Surgery, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Cardiac Surgery, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Cardiac Surgery, Medical University of Innsbruck, 6020 Innsbruck, AustriaBackground: For mitral valve surgery (MVS) in elderly, frail patients with increasing life expectancy, finding the least harmful means of access is a challenge. In the complexity of MVS approach evolution, using three different approaches (mini-thoracotomy (MT), partial upper-sternotomy (PS), full-sternotomy (FS), we developed a personalized, minimized-invasiveness algorithm for MVS. Methods: In this retrospective analysis, 517 elderly patients (≥70 years) were identified who had undergone MVS ± TV repair. MVS was performed via MT (<i>n</i> = 274), FS (<i>n</i> = 128) and PS (<i>n</i> = 115). The appropriate access type was defined according to several clinical patient conditions. Using uni- and multivariate regression models, we analyzed combined operative success (residual MV regurgitation, conversion to MV replacement or larger thoracic incisions); perioperative success (30-days mortality, thoracotomy, ECMO, pacemaker implantation, dialysis, longer ventilation); and reoperation-free long-term survival. An additional EuroSCORE2 adjustment was performed to reduce the bias of clinical conditions between all access types. Results: The EuroSCORE2-adjusted Cox regression analysis showed significantly increased reoperation-free survival in the MT cohort compared to FS (HR 0.640; 95% CI 0.442–0.926; <i>p</i> = 0.018). Mortality was additionally reduced after the implementation of PS (<i>p</i> = 0.023). Combined operative success was comparable between the three access types. The perioperative success was higher in the MT cohort compared to FS (OR 2.19, 95% CI 1.32–3.63; <i>p</i> = 0.002). Conclusion: Less-invasive approaches in elderly patients improve perioperative success and reoperation-free survival in those undergoing MVS procedures.https://www.mdpi.com/2308-3425/10/1/28elderly patientsmitral valve surgeryless invasivesurgical trauma reductionmitral valve repair |
| spellingShingle | Ulvi Cenk Oezpeker Fabian Barbieri Daniel Höfer Can Gollmann-Tepeköylü Johannes Holfeld Florian Sommerauer Julian Wagner Sasa Rajsic Suat Ersahin Nikolaos Bonaros Michael Grimm Müller Ludwig An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery Journal of Cardiovascular Development and Disease elderly patients mitral valve surgery less invasive surgical trauma reduction mitral valve repair |
| title | An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery |
| title_full | An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery |
| title_fullStr | An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery |
| title_full_unstemmed | An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery |
| title_short | An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery |
| title_sort | individualized less invasive surgical approach algorithm improves outcome in elderly patients undergoing mitral valve surgery |
| topic | elderly patients mitral valve surgery less invasive surgical trauma reduction mitral valve repair |
| url | https://www.mdpi.com/2308-3425/10/1/28 |
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