The best surgical approach for mitral valve repair is subject to wide debate. Findings from the randomised UK Mini Mitral trial showed similar improvement in patients undergoing minimally invasive or conventional surgical techniques for mitral valve repair in physical activity, surgical outcomes, and quality of life.
Dr Enoch Akowuah (James Cook University Hospital, UK) presented the results of the first multicentre, randomised controlled trial comparing 2 surgical approaches to mitral valve repair . The UK Mini Mitral trial (ISRCTN13930454) screened 1,167 patients and enrolled 330 patients with severe degenerative mitral regurgitation from 10 centres in the UK. The mean age was 67 years, 29% were women, and 40% had atrial fibrillation. They were randomised 1:1 to mitral valve repair by sternotomy or mini-thoracotomy. Surgeons had to have completed at least 50 procedures, and expertise-based randomisation was performed to account for the learning curve. The primary endpoint was a change in physical functioning and post-surgery return to daily activities, measured by the change in score on the 36-item short form (SF-36v2) physical functioning scale, from baseline to 12 weeks post-procedure.
At 12 weeks, no significant difference was seen between groups for the primary outcome of SF-36v2: mini-mitral valve repair 43.12 ±10.13 versus sternotomy 41.75 ±10.68; mean score difference 0.675 (95% CI -1.89 to 3.26; P=0.61). However, after 6 weeks, physical function had improved in the mini-thoracotomy group but not yet in the sternotomy group. The repair rate was high: 96% in both groups.
Dr Akowuah called the echocardiographic outcomes at 1 year excellent (93% mild MR or less). The length of hospital stay was shorter in the mini-thoracotomy group than in the sternotomy group, with a median of 5 versus 6 days. Early discharge was more than twice as likely in the mini-thoracotomy group. In this group, days alive and out of hospital were also more numerous at 30 days (difference 1.05; P=0.03) as well as at 90 days (1.03; P=0.03). Quality-of-life outcomes favoured the mini-thoracotomy at all time points. Rates of death, hospitalisation for heart failure, and reintervention on the mitral valve at 1 year were similar and low.
- Akowuah E, et al. Minimally invasive versus conventional sternotomy for mitral valve repair surgery: an expertise based multicentre randomised controlled trial (UK Mini Mitral). Session 405-08, ACC Scientific Session 2023, 4–6 March, New Orleans, USA.
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Table of Contents: ACC 2023
Letter from the Editor
ACC 2023 Highlights Podcast
Pulmonary Arterial Hypertension
Sotatercept improves exercise capacity in patients with PAH
Fixed-dose macitentan plus tadalafil superior to either agent alone in PAH
Immediate complete revascularisation non-inferior to staged complete revascularisation
RENOVATE-COMPLEX-PCI results support intravascular-guided PCI for complex lesions
Heart Failure and Cardiomyopathy
No need to restrict vigorous exercise in selected HCM patients?
No difference in CV outcomes between PET or CMR and SPECT
Interventional and Structural Cardiology
Benefits of MitraClip sustained to 5 years in COAPT trial
Transcatheter repair for patients with tricuspid regurgitation
Minimally invasive versus conventional sternotomy for mitral valve repair
Durable benefits of TAVR versus surgical aortic valve replacement in aortic stenosis patients
PCI not better than GDMT in severe ischaemic cardiomyopathy
Anticoagulation in non-critically ill hospitalised COVID patients
Statins associated with reduced heart dysfunction from anthracyclines
Multifaceted strategy improves prescription of therapies for diabetes and ASCVD
Bempedoic acid benefits statin-intolerant patients at high cardiovascular risk
Evolocumab improves coronary plaque morphology in stable CAD
Inflammation stronger predictor of MACE than cholesterol levels
Oral PCSK9 inhibitor significantly lowers LDL-C
Baxdrostat in patients with uncontrolled hypertension
Hormone therapy for gender dysphoria associated with increased CV risk
Pulsed-field ablation appears safe and effective for atrial fibrillation
Key correlates of incident dementia identified in the MESA study
Diabetes not related to abnormal biomarkers of Alzheimer’s disease