Impact of Minimally Invasive Mitral Valve Repair on Inflammatory, Coagulatory, and Functional Laboratory Parameters: A Comparative Analysis

Objectives: Aim of the study is to compare inflammatory, coagulation parameters, and cardiac and renal markers in patients undergoing MIMVR or conventional mitral valve repair as indicators for postoperative recovery.

Methods: A retrospective matched-pair analysis was performed in 74 patients (study group: age 59.91 ± 14.12 years, 29.7% female) undergoing isolated minimally-invasive 3D mitral valve repair from January to December 2016. A control group of patients with isolated mitral valve repair via sternotomy (control group) between 2013 and 2016 was retrieved from our database. Groups were matched regarding 7 preoperative patient characteristics (age, gender, BMI, comorbidities, mitral valve pathology, LV and RV function). Blood samples were collected pre- and postoperatively on days 1 to 5.

Results: There were no conversions to sternotomy in the study group. CPB and cross-clamp times were longer in the study group (175.34 ± 57.52/103.20 ± 34.33 min) compared to the control group (129.66 ± 39.73/79.79 ± 28.66 min; p < 0.001). ICU stay was 2 ± 2.8 days in the study group vs. 3.2 ± 3 days in the control group (p < 0.01). In both groups, an increase of inflammatory and coagulation biomarkers was observed. Acute phase proteins fibrinogen (5.7 ± 5.9 vs. 4.2 ± 4g/L; p < 0.001) and C-reactive protein (100.66 ± 50.95 vs. 67.73 ± 65.48 mg/L; p < 0.001) reached significantly higher levels postoperatively in the control versus study group. Thrombocytes reached lower levels in the control group early postoperatively (132.2 ± 143.8 vs. 150.6 ± 143.4 Mrd/L; p = 0.01). Alanine and aspartate aminotransferase (ALT/AST: p = 0.37/p = 0.31) were not significantly different between both groups. Creatinine kinase reached significantly higher levels early postoperatively in the study group (767.08 ± 2,781.5 vs. 63.82 ± 372.9 U/L; p < 0.001), but showed no difference on day 5 in comparison to the control group. For creatinine kinase MB and troponin I, no significant differences between groups were seen. Creatinine was significantly increased early postoperatively in the control group compared to the study group (1.29 ± 1.2 vs. 1.01 ± 0.7 mg/dL; p < 0.001).

Conclusions: In our study group, we found reduced inflammatory reaction, coagulation and renal markers in the study compared to control group, supporting clinical evidence of reduced faster recovery and postoperative bleeding. Our data support further application of MIMVR.