Minimally invasive approach compared to resternotomy for mitral valve surgery in patients with prior cardiac surgery: retrospective multicentre study based on the Netherlands Heart Registration

OBJECTIVES: Mitral valve (MV) surgery after prior cardiac surgery is conventionally performed through resternotomy and associated with increased morbidity and mortality. Alternatively, MV can be approached minimally invasively [minimally invasive mitral valve surgery (MIMVS)], but longer-term follow-up of this approach for MV surgery after prior cardiac surgery is lacking. Therefore, the aim of the current study is to evaluate short- and mid-term outcomes of MIMVS versus MV surgery through resternotomy in patients with prior sternotomy, using a nationwide registry. METHODS: Patients undergoing isolated MV surgery after prior cardiac surgery between 2013 and 2018 were included. Primary outcomes were short-term morbidity and mortality and mid-term survival. Cox proportional hazard analysis was used to investigate the association between surgical approach and mortality. Propensity score matching was used to correct for potential confounders. RESULTS: In total, 290 patients underwent MV surgery after prior cardiac surgery, of whom 205 patients were operated through resternotomy and 85 patients through MIMVS. No significant differences in 30-day mortality (3.4% vs 2%, P = 0.99) were observed between both groups. Five-year survival was 86.3% in the resternotomy group, compared to 89.4% in the MIMVS group (log-rank P = 0.45). In the multivariable analysis, surgical approach showed no relation with mid-term mortality [hazard ratio 0.73 (0.34-1.60); P = 0.44]. A lower incidence of prolonged intubation and new-onset arrhythmia was observed in MIMVS. CONCLUSIONS: MV surgery after prior cardiac surgery has excellent short- and mid-term results in the Netherlands, and MIMVS and resternotomy appear to be equally efficacious. MIMVS is associated with a lower incidence of new-onset arrhythmia and prolonged intubation

Minimally invasive approach compared to resternotomy for mitral valve surgery in patients with prior cardiac surgery: retrospective multicentre study based on the Netherlands Heart Registration

OBJECTIVES: Mitral valve (MV) surgery after prior cardiac surgery is conventionally performed through resternotomy and associated with increased morbidity and mortality. Alternatively, MV can be approached minimally invasively [minimally invasive mitral valve surgery (MIMVS)], but longer-term follow-up of this approach for MV surgery after prior cardiac surgery is lacking. Therefore, the aim of the current study is to evaluate short- and mid-term outcomes of MIMVS versus MV surgery through resternotomy in patients with prior sternotomy, using a nationwide registry. METHODS: Patients undergoing isolated MV surgery after prior cardiac surgery between 2013 and 2018 were included. Primary outcomes were short-term morbidity and mortality and mid-term survival. Cox proportional hazard analysis was used to investigate the association between surgical approach and mortality. Propensity score matching was used to correct for potential confounders. RESULTS: In total, 290 patients underwent MV surgery after prior cardiac surgery, of whom 205 patients were operated through resternotomy and 85 patients through MIMVS. No significant differences in 30-day mortality (3.4% vs 2%, P = 0.99) were observed between both groups. Five-year survival was 86.3% in the resternotomy group, compared to 89.4% in the MIMVS group (log-rank P = 0.45). In the multivariable analysis, surgical approach showed no relation with mid-term mortality [hazard ratio 0.73 (0.34-1.60); P = 0.44]. A lower incidence of prolonged intubation and new-onset arrhythmia was observed in MIMVS. CONCLUSIONS: MV surgery after prior cardiac surgery has excellent short- and mid-term results in the Netherlands, and MIMVS and resternotomy appear to be equally efficacious. MIMVS is associated with a lower incidence of new-onset arrhythmia and prolonged intubation

Impact of the coronavirus disease 2019 pandemic on volume of thoracic aortic surgery on a national level

OBJECTIVES: The aim of this study was to evaluate the effects of the coronavirus 2019 pandemic on elective and acute thoracic aortic surgery in the Netherlands. METHODS: The Netherlands Heart Registration database was used to compare the volume of elective and acute surgery on the thoracic aorta in 2019 and 2020, starting from week 11 in both years. A sub-analysis was done to assess the impact of the pandemic on high-volume and low-volume aortic centres. RESULTS: During the pandemic, the number of elective thoracic aortic operations declined by 18% [incidence rate ratio (IRR) 0.82 [0.73-0.91]; P < 0.01]. The decline in volume of elective surgery was significant in both high-volume (IRR 0.82 [0.71-0.94]; P < 0.01) and low-volume aortic centres (IRR 0.81 [0.68-0.98]; P = 0.03). The overall number of acute aortic operations during the pandemic remained similar to that in 2019 (505 vs 499; P = 0.85), but an increased share of these operations occurred at high-volume centres. The number of acute operations performed in high-volume centres increased by 20% (IRR 1.20 [1.01-1.42]; P = 0.04), while the number of acute operations performed in low-volume centres decreased by 17% (IRR 0.83 [0.69-1.00]; P = 0.04). CONCLUSIONS: The coronavirus 2019 pandemic led to a significant decrease in elective thoracic aortic surgery but did not cause a change in the volume of acute thoracic aortic surgery in the Netherlands. Moreover, the pandemic led to a centralization of care for acute thoracic aortic surgery