Top

Journal of Cardiothoracic Surgery

Published in:

Open Access 01-12-2021 | Heart Surgery | Research article

Incidence of postoperative pulmonary complications in patients undergoing minimally invasive versus median sternotomy valve surgery: propensity score matching

Authors: Mohamed Abdulkadir Mohamed, Cai Cheng, Xiang Wei

Published in: Journal of Cardiothoracic Surgery | Issue 1/2021

Abstract

Objective

Postoperative pulmonary complications (PPCs) are common incidents associated with an increased hospital stay, readmissions into the intensive care unit (ICU), increased costs, and mortality after cardiac surgery. Our study aims to analyze whether minimally invasive valve surgery (MIVS) can reduce the incidence of postoperative pulmonary complications compared to the full median sternotomy (FS) approach.

Methods

We reviewed the records of 1076 patients who underwent isolated mitral or aortic valve surgery (80 MIVS and 996 FS) in our institution between January 2015 and December 2019. Propensity score-matching analysis was used to compare outcomes between the groups and to reduce selection bias.

Results

Propensity score matching revealed no significant difference in hospital mortality between the groups. The incidence of PPCs was significantly less in the MIVS group than in the FS group (19% vs. 69%, respectively; P < 0.0001). The most common PPCs were atelectasis (P = 0.034), pleural effusions (P = 0.042), and pulmonary infection (P = 0.001). Prolonged mechanical ventilation time (> 24 h) (P = 0.016), blood transfusion amount (P = 0.006), length of hospital stay (P < 0.0001), and ICU stay (P < 0.0001) were significantly less in the MIVS group. Cardiopulmonary bypass (CBP), aortic cross-clamping, and operative time intervals were significantly longer in the MIVS group than in the matched FS group (P < 0.001). A multivariable analysis revealed a decreased risk of PPCs in patients undergoing MIVS (odds ratio, 0.25; 95% confidence interval, 0.006–0.180; P < 0.0001).

Conclusion

MIVS for isolated valve surgery reduces the risk of PPCs compared with the FS approach.

Bouhout I, Morgant MC, Bouchard D. Minimally invasive heart valve surgery. Can J Cardiol. 2017;33(9):1129–37. https://doi.org/10.1016/j.cjca.2017.05.014.CrossRefPubMed

Moustafa MA, Abdelsamad AA, Zakaria G, Omarah MM. Minimal vs median sternotomy for aortic valve replacement. Asian Cardiovasc Thorac Ann. 2007;15(6):472–5. https://doi.org/10.1177/021849230701500605.CrossRefPubMed

Raja SG, Navaratnarajah M. Impact of minimal access valve surgery on clinical outcomes: current best available evidence. J Card Surg. 2009;24(1):73–9.CrossRef

Lamelas J, Sarria A, Santana O, Pineda AM, Lamas GA. Outcomes of minimally invasive valve surgery versus median sternotomy in patients age 75 years or greater. Ann Thorac Surg. 2011;91(1):79–84.CrossRef

Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017;118(3):317–34. https://doi.org/10.1093/bja/aex002.CrossRefPubMed

Weissman C. Pulmonary complications after cardiac surgery. Semin Cardiothorac Vasc Anesth. 2004;8(3):185–211. https://doi.org/10.1177/108925320400800303.CrossRefPubMed

Canet J, Gallart L, Gomar C, Paluzie G, Valles J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6):1338–50. https://doi.org/10.1097/ALN.0b013e3181fc6e0a.CrossRefPubMed

Ufoaroh CU, Ele PU, Anyabolu AE, Enemuo EH, Emegoakor CD, Okoli CC, et al. Pre-operative pulmonary assessment and risk factors for post-operative pulmonary complications in elective abdominal surgery in Nigeria. Afr Health Sci. 2019;19(1):1745–56. https://doi.org/10.4314/ahs.v19i1.51.CrossRefPubMedPubMedCentral

Cosgrove DM 3rd, Sabik JF. Minimally invasive approach for aortic valve operations. Ann Thorac Surg. 1996;62(2):596–7.CrossRef

10.

Naveed A, Azam H, Murtaza HG, Ahmad RA, Baig MAR. Incidence and risk factors of pulmonary complications after cardiopulmonary bypass. Pak J Med Sci. 2017;33(4):993–6. https://doi.org/10.12669/pjms.334.12846.CrossRefPubMedPubMedCentral

11.

Badenes R, Lozano A, Belda FJ. Postoperative pulmonary dysfunction and mechanical ventilation in cardiac surgery. Crit Care Res Pract. 2015;2015: 420513. https://doi.org/10.1155/2015/420513.CrossRefPubMedPubMedCentral

12.

Sabate S, Mazo V, Canet J. Predicting postoperative pulmonary complications: implications for outcomes and costs. Curr Opin Anaesthesiol. 2014;27(2):201–9. https://doi.org/10.1097/ACO.0000000000000045.CrossRefPubMed

13.

Weissman C. Pulmonary function after cardiac and thoracic surgery. Curr Opin Anaesthesiol. 2000;13(1):47–51.CrossRef

14.

Foghsgaard S, Gazi D, Bach K, Hansen H, Schmidt TA, Kjaergard HK. Minimally invasive aortic valve replacement reduces atelectasis in cardiac intensive care. Acute Card Care. 2009;11(3):169–72. https://doi.org/10.1080/17482940903082228.CrossRefPubMed

15.

Bonacchi M, Prifti E, Giunti G, Frati G, Sani G. Does ministernotomy improve postoperative outcome in aortic valve operation? A prospective randomized study. Ann Thorac Surg. 2002;73(2):460–5. https://doi.org/10.1016/s0003-4975(01)03402-6.CrossRefPubMed

16.

Aris A, Camara ML, Montiel J, Delgado LJ, Galan J, Litvan H. Ministernotomy versus median sternotomy for aortic valve replacement: a prospective, randomized study. Ann Thorac Surg. 1999;67(6):1583–7. https://doi.org/10.1016/s0003-4975(99)00362-8.CrossRefPubMed

17.

Zhang QL, Chen Q, Lin ZQ, Yu LL, Lin ZW, Cao H. Thoracoscope-right assisted mitral valve replacement with a small incision in the chest: a Chinese single cardiac center experience. Med Sci Monit. 2018;24:1054–63. https://doi.org/10.12659/msm.905855.CrossRefPubMedPubMedCentral

18.

Camp SL, Stamou SC, Stiegel RM, Reames MK, Skipper ER, Madjarov J, et al. Quality improvement program increases early tracheal extubation rate and decreases pulmonary complications and resource utilization after cardiac surgery. J Card Surg. 2009;24(4):414–23. https://doi.org/10.1111/j.1540-8191.2008.00783.x.CrossRefPubMed

19.

Al-Qubati FAA, Damag A, Noman T. Incidence and outcome of pulmonary complications after open cardiac surgery, Thowra Hospital, Cardiac center, Sana’a, Yemen. Egypt J Chest Dis Tuberc. 2013;62(4):775–80. https://doi.org/10.1016/j.ejcdt.2013.08.008.CrossRef

20.

Koch CG, Li L, Duncan AI, Mihaljevic T, Cosgrove DM, Loop FD, et al. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med. 2006;34(6):1608–16. https://doi.org/10.1097/01.CCM.0000217920.48559.D8.CrossRefPubMed

Title: Incidence of postoperative pulmonary complications in patients undergoing minimally invasive versus median sternotomy valve surgery: propensity score matching
Authors: Mohamed Abdulkadir Mohamed
Cai Cheng
Xiang Wei
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Heart Surgery
Heart Surgery
Sternotomy
Minimally Invasive Surgery
Published in: Journal of Cardiothoracic Surgery / Issue 1/2021
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-021-01669-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Incidence of postoperative pulmonary complications in patients undergoing minimally invasive versus median sternotomy valve surgery: propensity score matching

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Re-exploration for bleeding after cardiac surgery: revaluation of urgency and factors promoting low rate

Axillary uniportal video-assisted thoracoscopic surgery for bullae is a cosmetically superior approach to primary spontaneous pneumothorax: a case report

COVID-19 related mortality in post-operative cardiac surgical patients

Retention of Bovie scratch pad radio-opaque marker during VATS Pleurodesis: case report

Perforation of the atrial wall and aortic sinus after closure of an atrial septal defect with an Atriasept occluder: a case report

The use of fibrinolytic therapy for parapneumonic effusion in pregnancy: a case report and a review