Comparison Of Thoracoscopic Minimally Invasive Surgery With Traditional Median Thoracotomy For Early Prognosis Of Mitral Valve Disease: A Multicenter, Propensity Score Matching Study

Background:The present study aimed to compare the early outcomes of isolated mitral valve thoracoscopic surgery(thoracoscopic)verse median sternotomy(open)using the data from Chinese Cardiovascular Surgery Registry(CCSR),which was initiated in 2004 and has recorded surgical data from 131 hospitals nationwide.The perioperative parameters among thoracoscopic patients from different centers were further compared to assess the regional differences of thoracoscopic surgery in treating mitral valve diseases.Methods:1.Between January 2012 and October 2016,isolated mitral valve were performed in 277 patients with a totally thoarcoscopic approach or thoracosopic assistance and in 2132 patients with median sternotomy from 6 hospitals nationwide.To account for key differences in preoperative risk profiles,propensity scores identified 250 well-matched patient pairs of the two groups and early in-hospital outcomes were compared between the two groups.2.The perioperative parameters and early outcomes were further compared among thoracoscopic patients from different hospitals.Results:1.The average age of patients in thoracoscopic group was 47.81 ±11.57,with repair performed in 65 patients(23.5%)and replacement in 212 patients(76.5%).Between propensity-matched thoracoscopic and open group,both in-hospital mortality(0.4%vs 0.4%,P=1.000)and reoperation(3.6%VS 2.8%,P=1.000)was identical.The incidence of early in-hospital complications including stroke,pericardial tamponade and acute renal failure were also comparable.However,thoracosocpic group had significantly longer Cross-clamp time(70.07±29.98 VS 54.99:±34.06 minutes,P<0.0001)and bypass time(116.09±39.94 VS 88.07 ±51.47minutes,P<0.00001)but shorter length of ICU stays(53.67 ±34.19 vs 135.73 ±1152.3 hours,P=0.0107).The incidence of perioperative blood transfusion in thoracoscopic group was significantly higher compared with open group(171/250,68.4%VS 99/250,39.6%,P<0.0001),but the frequency was significantly decreased during the past two years.The hospital costs were slightly higher in thoracoscopic group but did not reach statistical significance.2.The early outcomes among patients from 6 hospitals were comparable,but there ere significant differences of perioperative parameters including the operation time,incidence of blood transfusion and the time of ICU stays.Conclusion:Early outcomes of isolated mitral valve thoracoscopic surgery were similar to those performed through median sternotomy in China,which indicated it was a safe and reproducible procedure.However,the perioperative parameters among patients from different hospitals were significantly different,indicating the regional imbalance of thoracoscopic technique in China.