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

Objective: 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. Methods: 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. Results: 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). Conclusions: 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. (J Thorac Cardiovasc Surg 2011; 141: 1461-68)