Preliminary Results of Minimally Invasive Triple Valve Surgery through Upper Partial Sternotomy: A Nine-Year Single-Centre Experience

Objectives: Combined mitral, tricuspid and aortic valve surgery is one of the most demanding cardiac procedures associated with high operative mortality. Current literature reports operative mortality rates up to 17%. In this context, the advantages of minimal invasive approach through an upper partial sternotomy (UPS) is still unsettled in view of the prolonged operation time and the consequent additional risk. The aim of this study is to report the preliminary results of UPS and to compare them to the standard median sternotomy (MS).

Methods: A total of 66 patients underwent triple valve surgery in our institution between November 2011 and May 2020. Excluding redo-surgery and concomitant surgical revascularization, 32 consecutive patients were included in this Study. UPS group included 15 patients whereas MS group 17 patients respectively. Data were prospectively collected and retrieved from our institutional database (QIMS) at the study time. Outcomes of both groups were compared considering the following endpoints: 30-day mortality, surgical site infection (SSI) rates and length of ICU and hospital stay.

Result: The UPS group was slightly older (77.3 ± 20.4 vs. 75.1 ± 8.4; p = 0.69) with a lower proportion of women (33 vs. 64%; p = 0.16). The EuroSCORE II was not significantly different between groups (10.4 ± 8.8 vs. 12.1 ± 9.3; p = 0.6). In the UPS group, there was a higher mitral repair rate (60 vs. 29.4%; p = 0.15). The X-clamp time was higher in UPS group (139.6 ± 40.6 in UPS group vs. 125.3 ± 27.8 in the MS group; p = 0.24). SSI rate was not significantly different in both groups (0% in UPS group vs. 1% in the MS group p = 1.0). UPS group did not show a higher 30-day mortality (13.3 vs. 11.8%; p = 1.0). The mean hospital and ICU stays were not significantly different (UPS: 14.1 ± 8.5 vs. MS: 19.5 ± 17.1; p = 0.23 and 3.8 ± 5.7 vs. 7.9 ± 15.2; p = 0.33 respectively).

Conclusion: Despite the low number of patients required for more solid evidence, this single-center study shows that triple valve surgery performed through UPS has acceptable early results and can be feasibly performed without additional risk for patients. The better thorax stability along with the improved cosmetic outcomes prompt us to a wider use of this approach.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021