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An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery
Background: For mitral valve surgery (MVS) in elderly, frail patients with increasing life expectancy, finding the least harmful means of access is a challenge. In the complexity of MVS approach evolution, using three different approaches (mini-thoracotomy (MT), partial upper-sternotomy (PS), full-s...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9862192/ https://www.ncbi.nlm.nih.gov/pubmed/36661923 http://dx.doi.org/10.3390/jcdd10010028 |
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author | Oezpeker, Ulvi Cenk Barbieri, Fabian Höfer, Daniel Gollmann-Tepeköylü, Can Holfeld, Johannes Sommerauer, Florian Wagner, Julian Rajsic, Sasa Ersahin, Suat Bonaros, Nikolaos Grimm, Michael Ludwig, Müller |
author_facet | Oezpeker, Ulvi Cenk Barbieri, Fabian Höfer, Daniel Gollmann-Tepeköylü, Can Holfeld, Johannes Sommerauer, Florian Wagner, Julian Rajsic, Sasa Ersahin, Suat Bonaros, Nikolaos Grimm, Michael Ludwig, Müller |
author_sort | Oezpeker, Ulvi Cenk |
collection | PubMed |
description | Background: For mitral valve surgery (MVS) in elderly, frail patients with increasing life expectancy, finding the least harmful means of access is a challenge. In the complexity of MVS approach evolution, using three different approaches (mini-thoracotomy (MT), partial upper-sternotomy (PS), full-sternotomy (FS), we developed a personalized, minimized-invasiveness algorithm for MVS. Methods: In this retrospective analysis, 517 elderly patients (≥70 years) were identified who had undergone MVS ± TV repair. MVS was performed via MT (n = 274), FS (n = 128) and PS (n = 115). The appropriate access type was defined according to several clinical patient conditions. Using uni- and multivariate regression models, we analyzed combined operative success (residual MV regurgitation, conversion to MV replacement or larger thoracic incisions); perioperative success (30-days mortality, thoracotomy, ECMO, pacemaker implantation, dialysis, longer ventilation); and reoperation-free long-term survival. An additional EuroSCORE2 adjustment was performed to reduce the bias of clinical conditions between all access types. Results: The EuroSCORE2-adjusted Cox regression analysis showed significantly increased reoperation-free survival in the MT cohort compared to FS (HR 0.640; 95% CI 0.442–0.926; p = 0.018). Mortality was additionally reduced after the implementation of PS (p = 0.023). Combined operative success was comparable between the three access types. The perioperative success was higher in the MT cohort compared to FS (OR 2.19, 95% CI 1.32–3.63; p = 0.002). Conclusion: Less-invasive approaches in elderly patients improve perioperative success and reoperation-free survival in those undergoing MVS procedures. |
format | Online Article Text |
id | pubmed-9862192 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-98621922023-01-22 An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery Oezpeker, Ulvi Cenk Barbieri, Fabian Höfer, Daniel Gollmann-Tepeköylü, Can Holfeld, Johannes Sommerauer, Florian Wagner, Julian Rajsic, Sasa Ersahin, Suat Bonaros, Nikolaos Grimm, Michael Ludwig, Müller J Cardiovasc Dev Dis Article Background: For mitral valve surgery (MVS) in elderly, frail patients with increasing life expectancy, finding the least harmful means of access is a challenge. In the complexity of MVS approach evolution, using three different approaches (mini-thoracotomy (MT), partial upper-sternotomy (PS), full-sternotomy (FS), we developed a personalized, minimized-invasiveness algorithm for MVS. Methods: In this retrospective analysis, 517 elderly patients (≥70 years) were identified who had undergone MVS ± TV repair. MVS was performed via MT (n = 274), FS (n = 128) and PS (n = 115). The appropriate access type was defined according to several clinical patient conditions. Using uni- and multivariate regression models, we analyzed combined operative success (residual MV regurgitation, conversion to MV replacement or larger thoracic incisions); perioperative success (30-days mortality, thoracotomy, ECMO, pacemaker implantation, dialysis, longer ventilation); and reoperation-free long-term survival. An additional EuroSCORE2 adjustment was performed to reduce the bias of clinical conditions between all access types. Results: The EuroSCORE2-adjusted Cox regression analysis showed significantly increased reoperation-free survival in the MT cohort compared to FS (HR 0.640; 95% CI 0.442–0.926; p = 0.018). Mortality was additionally reduced after the implementation of PS (p = 0.023). Combined operative success was comparable between the three access types. The perioperative success was higher in the MT cohort compared to FS (OR 2.19, 95% CI 1.32–3.63; p = 0.002). Conclusion: Less-invasive approaches in elderly patients improve perioperative success and reoperation-free survival in those undergoing MVS procedures. MDPI 2023-01-11 /pmc/articles/PMC9862192/ /pubmed/36661923 http://dx.doi.org/10.3390/jcdd10010028 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Oezpeker, Ulvi Cenk Barbieri, Fabian Höfer, Daniel Gollmann-Tepeköylü, Can Holfeld, Johannes Sommerauer, Florian Wagner, Julian Rajsic, Sasa Ersahin, Suat Bonaros, Nikolaos Grimm, Michael Ludwig, Müller An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery |
title | An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery |
title_full | An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery |
title_fullStr | An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery |
title_full_unstemmed | An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery |
title_short | An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery |
title_sort | individualized, less-invasive surgical approach algorithm improves outcome in elderly patients undergoing mitral valve surgery |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9862192/ https://www.ncbi.nlm.nih.gov/pubmed/36661923 http://dx.doi.org/10.3390/jcdd10010028 |
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