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. 2025 Apr 7;17(4):e81859.
doi: 10.7759/cureus.81859. eCollection 2025 Apr.

Survival Analysis of Minimally Invasive Mitral Valve Surgery Versus Conventional Median Sternotomy in the United States

Songphol Tungjitviboonkun  1
Affiliations

Survival Analysis of Minimally Invasive Mitral Valve Surgery Versus Conventional Median Sternotomy in the United States

Songphol Tungjitviboonkun. Cureus. .

Erratum in

Abstract

Background: Minimally invasive mitral valve surgery (MiMVS), particularly via right mini-thoracotomy, has gained popularity as an alternative to median sternotomy, potentially reducing surgical trauma and recovery time. However, recent data on its surgical outcomes remain limited. To provide updated insights while minimizing selection bias, we analyzed elective patients undergoing mitral valve surgery, comparing MiMVS and sternotomy in terms of survival, operative times, and perioperative complications.

Methods: We conducted a single-center retrospective cohort study that included patients who underwent mitral valve surgery between 2015 and 2024. Patients were stratified into MiMVS or sternotomy groups. Kaplan-Meier survival curves and log-rank tests assessed survival, while propensity score matching (PSM) minimized selection bias.

Results: Among 422 patients (319 MiMVS, 103 sternotomy), the MiMVS group had a shorter hospital stay (5.0 vs. 8.0 days, p < 0.01) and lower postoperative bleeding (3.9% vs. 9%). Median cross-clamp and cardiopulmonary bypass (CPB) times were shorter in MiMVS (76 vs. 94 min, p < 0.01; and 114 vs. 140 min, p < 0.01, respectively). Survival analysis showed no significant difference between groups (log-rank p = 0.07) after PSM. The adjusted hazard ratio for mortality in MiMVS versus sternotomy was 0.30 (95% CI: 0.08-1.12, p = 0.07). However, mitral replacement was associated with a significantly higher mortality risk than mitral repair (HR 5.22, 95% CI: 1.26-21.61, p = 0.04). In-hospital mortality was comparable (1.9% for sternotomy vs. 0.6% for MiMVS, p = 0.25). Reoperation rates at five and 10 years were lower in MiMVS (1.7% vs. 2.1% at five years and 1.7% vs. 3.2% at 10 years).

Conclusions: While MiMVS offers advantages such as shorter hospital stays and lower postoperative bleeding rates, no statistically significant difference in overall survival was found compared to sternotomy. However, a trend toward improved survival with MiMVS was observed. Notably, mitral valve replacement was associated with a significantly higher mortality risk than mitral repair, emphasizing the importance of prioritizing repair whenever feasible.

Keywords: mini-mitral surgery; mini-thoracotomy; minimally invasive surgery; retrospective cohort study; survival analysis.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Kaplan-Meier survival curves by the surgical approach
Figure 2
Figure 2. Kaplan-Meier survival curves by surgical approach after PSM
PSM: Propensity score matching
Figure 3
Figure 3. Kaplan-Meier survival curves by procedure type after PSM
PSM: Propensity score matching
Figure 4
Figure 4. Histogram shows the number of mitral valve surgeries conducted per year between 2015 and 2024
See this image and copyright information in PMC

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