Less invasive versus conventional double-valve surgery: a propensity-matched comparison.

Abstract

Less invasive approaches to double-valve surgery are used for improved cosmesis; however, few studies have investigated their effect on outcome. We sought to compare these less invasive approaches with conventional full sternotomy. From January 1995 to January 2004, 114 patients underwent primary double-valve surgery through a less invasive approach and 381 through conventional sternotomy. Because there were important differences in the patients' characteristics, a propensity score based on 42 factors was used to obtain 81 well-matched patient pairs (71% of possible matches) for comparison of in-hospital morbidity and mortality, mediastinal drainage, transfusion requirements, pulmonary function, pain, and long-term survival. In-hospital mortality was similar for propensity-matched patients: 6.2% (5/81) for those undergoing less invasive surgery and 2.5% (2/81) for those undergoing conventional sternotomy (P > .4). Occurrences of stroke (P > .9), renal failure (P = .4), myocardial infarction (P > .9), and infection (P > .9) were also similar. However, 24-hour mediastinal drainage was less after less invasive surgery (median, 250 vs 400 mL; P < .0001), but a similar proportion of patients received transfusions (28% vs 40%, P = .2). An equivalent proportion of patients were extubated in the operating room (7.7% vs 7.0%, P > .9), and median hours to extubation were similar (5.0 vs 6.5 hours). Pain scores were equivalent (P > .3). Long-term survival was also similar (82% and 76% at 10 years, P = .07). Within that portion of the spectrum of double-valve surgery in which propensity matching was possible, less invasive surgery had cosmetic and blood product use advantages over conventional surgery and no apparent detriments.