Conventional versus Minimally Invasive Mitral Valve Surgery: A Comparative Analysis of Clinical Outcomes and Patient Recovery

Mahmoud M Abdel Azeem  Mubarak; Noha Abdelkader Nabeeh Metawea; Ahmed  M Abdelazim

Mahmoud M Abdel Azeem Mubarak Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Noha Abdelkader Nabeeh Metawea Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Ahmed M Abdelazim Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt

Keywords: Mitral valve surgery, Minimally invasive surgery, Conventional sternotomy, Cardiac surgery, Postoperative outcomes

Abstract

Background: The evolution of surgical techniques has led to increased adoption of minimally invasive mitral valve surgery, yet comprehensive comparative analyses of clinical outcomes remain essential for optimal patient selection and surgical planning. This study compared the clinical outcomes, operative characteristics, and postoperative recovery parameters between conventional and minimally invasive mitral valve surgery.

Methods: This prospective cohort study analyzed 100 patients undergoing mitral valve repair (MVR), with 50 patients in each group (conventional MVR n=50, minimally invasive MVR n=50).

Results: Significant demographic differences were observed between groups, with the conventional group being older (52.32±10.19 vs 42.68±11.95 years, p<0.001) and having lower rates of hypertension (22% vs 42%, p=0.032), chronic kidney disease (14% vs 42%, p=0.002), and smaller left atrial dimensions (4.3 vs 4.65 cm, p<0.001). The minimally invasive group demonstrated significantly longer cardiopulmonary bypass times (100 vs 136 minutes, p<0.001) and ischemic times (64 vs 79 minutes, p<0.001). However, the minimally invasive approach was associated with significantly reduced intensive care unit stay (4 vs 3 days, p<0.001), shorter hospital length of stay (9 vs 8 days, p<0.001), and decreased ventilation time (9 vs 7 hours, p<0.001). However, the conventional approach had markedly improved pain scores, with 2% experiencing severe pain compared to 30% in the minimally invasive group (p<0.001). Postoperative complications showed comparable bleeding rates (10% vs 12%, p=0.749) and wound infections (8% vs 2%, p=0.362), though the minimally invasive group had higher rates of pleural effusion (2% vs 26%, p=0.001).

Conclusions: Minimally invasive mitral valve surgery demonstrates comparable safety profiles to conventional approaches while offering significant advantages in postoperative recovery, including reduced hospital stay and shorter ventilation requirements. However, the technique requires longer operative times and may be associated with specific complications such as pleural effusion. These findings support the continued development and selective application of minimally invasive techniques in mitral valve surgery.