Right miniparasternotomy may be a good minimally invasive alternative to full sternotomy for cardiac valve operations

A propensity-Adjusted analysis

Kuan Ming Chiu, Robert J. Chen, Tzu Yu Lin, Jer Shen Chen, Jin Hsin Huang, Chun Yang Huang, Shu Hsun Chu

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: Limited real-world data existed for mini-parasternotomy approach with good sample size in Asian cohorts and most previous studies were eclipsed by case heterogeneity. The goal of this study was to compare safety and quality outcomes of cardiac non-coronary valve operations by mini-parasternotomy and full sternotomy approaches on risk-Adjusted basis. Methods: From our hospital database, we retrieved the cases of non-coronary valve operations from 1 January 2005 to 31 December 2012, including re-do, emergent, and combined procedures. Estimated EuroScore-II and propensity score for choosing mini-parasternotomy were adjusted for in the regression models on hospital mortality, complications (pneumonia, stroke, sepsis, etc.), and quality parameters (length of stay, ICU time, ventilator time, etc.). Non-complicated cases, defined as survival to discharge, ventilator use not over one week, and intensive care unit stay not over two weeks, were used for quality parameters. Results: There were 283 mini-parasternotomy and 177 full sternotomy cases. EuroScore-II differed significantly (medians 2.1 vs. 4.7, PP<0.001). Propensity scores for choosing mini-parasternotomy were higher with lower EuroScore-II (OR=0.91 per 1%, PP<0.001), aortic regurgitation (OR=2.3, P=0.005), and aortic non-mitral valve disease (OR=3.9, PP<0.001). Adjusted for propensity score and EuroScore-II, miniparasternotomy group had less pneumonia (OR=0.32, P=0.043), less sepsis (OR=0.31, P=0.045), and shorter non-complicated length of stay (coefficient=-7.2 (day), PP<0.001) than full sternotomy group, whereas Kaplan-Meier survival, non-complicated ICU time, non-complicated ventilator time, and 30-day mortality did not differ significantly. Conclusion: The propensity-Adjusted analysis demonstrated encouraging safety and quality outcomes for mini-parasternotomy valve operation in carefully selected patients.

Original languageEnglish
Pages (from-to)111-120
Number of pages10
JournalJournal of Cardiovascular Surgery
Volume57
Issue number1
Publication statusPublished - Feb 1 2016
Externally publishedYes

Fingerprint

Sternotomy
Heart Valves
Propensity Score
Mechanical Ventilators
Length of Stay
Sepsis
Pneumonia
Safety
Survival
Aortic Valve Insufficiency
Hospital Mortality
Sample Size
Intensive Care Units
Stroke
Databases
Mortality

Keywords

  • Cardiac Surgical Procedures
  • Heart valves.
  • Minimally invasive
  • Surgical procedures

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Right miniparasternotomy may be a good minimally invasive alternative to full sternotomy for cardiac valve operations : A propensity-Adjusted analysis. / Chiu, Kuan Ming; Chen, Robert J.; Lin, Tzu Yu; Chen, Jer Shen; Huang, Jin Hsin; Huang, Chun Yang; Chu, Shu Hsun.

In: Journal of Cardiovascular Surgery, Vol. 57, No. 1, 01.02.2016, p. 111-120.

Research output: Contribution to journalArticle

Chiu, Kuan Ming ; Chen, Robert J. ; Lin, Tzu Yu ; Chen, Jer Shen ; Huang, Jin Hsin ; Huang, Chun Yang ; Chu, Shu Hsun. / Right miniparasternotomy may be a good minimally invasive alternative to full sternotomy for cardiac valve operations : A propensity-Adjusted analysis. In: Journal of Cardiovascular Surgery. 2016 ; Vol. 57, No. 1. pp. 111-120.
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T2 - A propensity-Adjusted analysis

AU - Chiu, Kuan Ming

AU - Chen, Robert J.

AU - Lin, Tzu Yu

AU - Chen, Jer Shen

AU - Huang, Jin Hsin

AU - Huang, Chun Yang

AU - Chu, Shu Hsun

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N2 - BACKGROUND: Limited real-world data existed for mini-parasternotomy approach with good sample size in Asian cohorts and most previous studies were eclipsed by case heterogeneity. The goal of this study was to compare safety and quality outcomes of cardiac non-coronary valve operations by mini-parasternotomy and full sternotomy approaches on risk-Adjusted basis. Methods: From our hospital database, we retrieved the cases of non-coronary valve operations from 1 January 2005 to 31 December 2012, including re-do, emergent, and combined procedures. Estimated EuroScore-II and propensity score for choosing mini-parasternotomy were adjusted for in the regression models on hospital mortality, complications (pneumonia, stroke, sepsis, etc.), and quality parameters (length of stay, ICU time, ventilator time, etc.). Non-complicated cases, defined as survival to discharge, ventilator use not over one week, and intensive care unit stay not over two weeks, were used for quality parameters. Results: There were 283 mini-parasternotomy and 177 full sternotomy cases. EuroScore-II differed significantly (medians 2.1 vs. 4.7, PP<0.001). Propensity scores for choosing mini-parasternotomy were higher with lower EuroScore-II (OR=0.91 per 1%, PP<0.001), aortic regurgitation (OR=2.3, P=0.005), and aortic non-mitral valve disease (OR=3.9, PP<0.001). Adjusted for propensity score and EuroScore-II, miniparasternotomy group had less pneumonia (OR=0.32, P=0.043), less sepsis (OR=0.31, P=0.045), and shorter non-complicated length of stay (coefficient=-7.2 (day), PP<0.001) than full sternotomy group, whereas Kaplan-Meier survival, non-complicated ICU time, non-complicated ventilator time, and 30-day mortality did not differ significantly. Conclusion: The propensity-Adjusted analysis demonstrated encouraging safety and quality outcomes for mini-parasternotomy valve operation in carefully selected patients.

AB - BACKGROUND: Limited real-world data existed for mini-parasternotomy approach with good sample size in Asian cohorts and most previous studies were eclipsed by case heterogeneity. The goal of this study was to compare safety and quality outcomes of cardiac non-coronary valve operations by mini-parasternotomy and full sternotomy approaches on risk-Adjusted basis. Methods: From our hospital database, we retrieved the cases of non-coronary valve operations from 1 January 2005 to 31 December 2012, including re-do, emergent, and combined procedures. Estimated EuroScore-II and propensity score for choosing mini-parasternotomy were adjusted for in the regression models on hospital mortality, complications (pneumonia, stroke, sepsis, etc.), and quality parameters (length of stay, ICU time, ventilator time, etc.). Non-complicated cases, defined as survival to discharge, ventilator use not over one week, and intensive care unit stay not over two weeks, were used for quality parameters. Results: There were 283 mini-parasternotomy and 177 full sternotomy cases. EuroScore-II differed significantly (medians 2.1 vs. 4.7, PP<0.001). Propensity scores for choosing mini-parasternotomy were higher with lower EuroScore-II (OR=0.91 per 1%, PP<0.001), aortic regurgitation (OR=2.3, P=0.005), and aortic non-mitral valve disease (OR=3.9, PP<0.001). Adjusted for propensity score and EuroScore-II, miniparasternotomy group had less pneumonia (OR=0.32, P=0.043), less sepsis (OR=0.31, P=0.045), and shorter non-complicated length of stay (coefficient=-7.2 (day), PP<0.001) than full sternotomy group, whereas Kaplan-Meier survival, non-complicated ICU time, non-complicated ventilator time, and 30-day mortality did not differ significantly. Conclusion: The propensity-Adjusted analysis demonstrated encouraging safety and quality outcomes for mini-parasternotomy valve operation in carefully selected patients.

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