Endoscopic Minimally Invasive Approach Versus Median Sternotomy for Multiple-Valve Surgery: A Propensity-Matched Analysis.

Introduction: Endoscopic minimally invasive valve surgery is a promising alternative to valve surgery through median sternotomy. Our study compared the short-term outcomes of patients undergoing endoscopic minimally invasive multiple concomitant valve surgeries (MIMVS) with median sternotomy (MS).

Methods: Demographic, clinical, and procedural data of all consecutive patients who underwent multiple-valve surgeries at two institutions in Germany from March of 2017 to March of 2023 were retrospectively collected. Patients were divided into two groups: MIMVS versus MS and their outcomes were compared before and after propensity score matching. Primary endpoint was the incidence of 30-day mortality.

Results: A total of 317 patients were included in the study; 112 patients in each group were matched 1:1. MIMVS was performed on 123 patients. After propensity matching, 30-day mortality rates were 8% for MIMVS versus 12.5% for MS (p = 0.28). Median blood transfusion in the MIMVS group was 0 [0-3] vs 1 [0-4] in the MS group (p = 0.002). MIMVS was associated with similar cardiopulmonary bypass time 105.5 [79.8-124] versus 98 [68.8-130.3] mins and aortic cross clamping times 70 [53-80.3] versus 63.5 [46-90.3] mins (p values 0.9 and 0.76, respectively). Median intensive care and inhospital stays were similar between both groups (2 [1-4] vs 2 [1-5] days, p = 0.36, and 12 [8-17] vs 12.5 [9-21] days, p = 0.38). Incidences of intrathoracic bleeding, stroke, and acute kidney injury were similar in both groups.

Conclusions: In our experience, endoscopic minimally invasive multiple-valve surgeries through right anterior mini-thoracotomy is as feasible, safe, and effective as medial sternotomy in select patients.