Trans-axillary approach enhances postoperative recovery after mitral valve surgery

Objectives: Several thoracic incisions have been described and different techniques used for cardiopulmonary bypass, myocardial protection, and valve exposure in minimally invasive mitral valve surgery (MIMVS). Aim of this study is to compare the early outcomes of patients operated using a simplified minimally invasive approach through a right trans-axillary (TAxA) access with those achieved with conventional full sternotomy (FS) operations. Methods: Prospectively collected data of patients who underwent mitral valve surgery between 2017 and 2022 at two academic centres were reviewed. Among them, 454 patients were operated through MIMVS TAxA access and 667 patients through FS; associated aortic and CABG procedures, infective endocarditis, redo and urgent operations were excluded. A propensity match analysis was performed using seventeen preoperative variables. Results: Two well balanced cohorts including a total of 804 patients were analysed. The rate of mitral valve repair was similar in both groups. Operative times were shorter in FS group, nevertheless in patients operated with a minimally invasive approach there was a trend towards decreasing crossclamp time over the study period (p = 0.07). In TAxA group 30-day mortality was 0.25%, postoperative cerebral stroke rate was 0.7%. TAxA mitral surgery was associated with shorter intubation time (p < 0.001) and ICU stay (p < 0.001). After a median hospital stay of 8 days, 30% of patients who had TAxA surgery were discharged home vs. 5% in the FS group (p < 0.001). Conclusions: When compared with FS access, TAxA approach provides at least similar excellent early outcomes in terms of perioperative morbidity and mortality and allows shorter mechanical ventilation time, ICU and postoperative hospital stay with a higher rate of patients able to be discharged home without any further period of cardiopulmonary rehabilitation.