Is Minithoracotomy a better alternative than conventional Sternotomy for mitral valve repair?
UK: Minithoracotomy was shown to be non-superior to sternotomy in the recovery of physical function at 12 weeks for degenerative mitral regurgitation in a recent study in JAMA (Journal of the American Medical Association) 2023 issue.
The randomized clinical trial involving 330 patients showed that minimally invasive repair was not superior to sternotomy as determined by recovery of physical function at 12 weeks. Both techniques achieved durable and high-quality valve repair in one year with similar postoperative complications.
Minithoracotomy achieved quality and valve repair rates, yielding similar postoperative complications at one year to sternotomy. "The results provide evidence to inform shared decision-making and treatment guidelines," the researchers wrote.
A pragmatic, multicentre, superiority, randomized clinical trial was conducted by researchers with 330 participants with degenerative mitral regurgitation undergoing mitral valve repair surgery to compare the safety and effectiveness of minithoracotomy vs sternotomy mitral valve repair.
This study showed a primary outcome which included physical functioning and associated return to usual activities measured by a physical functioning scale 12 weeks after the index surgery, assessed by an independent researcher masked to the intervention. Secondary outcomes included recurrent mitral regurgitation grade, physical activity, and quality of life.
Some of the findings are highlighted as follows:
- Of 330 randomised participants (mean age, 67 years, 100 females [30%]), 166 and 164 were allocated to minithoracotomy, and sternotomy.
- At 12 weeks, the mean between-group difference in the change in the SF-36 physical function T score was 0.68.
- Safety outcomes occurred in 5.4% of patients undergoing minithoracotomy and 6.1% undergoing sternotomy at one year.
- The minimally invasive repair was not superior to sternotomy as determined by recovery of physical function at 12 weeks.
“Minithoracotomy achieves high rates and quality of valve repair and has similar safety outcomes at one year to sternotomy. These findings can promote healthcare professionals and people using services to work together to make decisions about treatment guidelines,” the researchers also reported.
References:
Akowuah EF, Maier RH, et al. “Minithoracotomy Vs Conventional Sternotomy for Mitral Valve Repair.A Randomized Clinical Trial”. JAMA. 2023;329(22):1957-1966. doi:10.1001/jama.2023.7800
