Equivalent recovery times shown between minimally invasive and conventional surgery for mitral valve repair

The largest randomised controlled trial to date to compare minimally invasive and conventional mitral valve surgery—UK Mini Mitral—has found outcomes and quality of life to be similar in patients who received either technique for at 12 weeks.

Presented at the American College of Cardiology (ACC) annual Scientific Session (4–6 March, New Orleans, USA), lead author Enoch Akowuah (Newcastle University, Newcastle upon Tyne, UK) investigated patients with severe degenerative mitral valve regurgitation to assess recovery and subsequent complications.

The study included 330 patients treated at 10 centres across the UK—the cohort’s average age was 67 years—30% of whom were women. Participants were randomly assigned to undergo mitral valve repair by either sternotomy or mini-thoracotomy.

Expertise randomisation was a focal area of the study—28 surgeons were approved by the Trial Steering Committee and were required to have performed at least 50 procedures—and Akowuah stated that this was based on patient feedback prior to the study’s design to “remove the learning curve” and assure patients would receive a “high-quality procedure” regardless of group designation.

The researchers outlined their primary endpoint as the change in patients’ physical functioning and ability to carry out day-to-day activities at 12 weeks post-procedure. This was measured by changes in SF-36v2 quality-of-life and physical functioning scale from baseline. Akowuah et al assessed changes through periodic questionnaires and updates via an accelerometer that patients wore on their wrists.

Defining their secondary endpoint, the researchers included physical function at six weeks, physical activity and sleep efficiency measure via accelerometery at both six and 12 weeks, MVr rates, quality of mitral valve repair and adverse events, such as death, stroke, heart failure and repeat intervention.

When assessed at 12 weeks, Akowuah and colleagues found physical function levels pre- and post-surgery were similar in both groups. Although at six weeks, they noted, who underwent minithoracotomy had recovered physical function compared to pre-surgery, whereas patients who received a sternotomy had not.