Improved Patient Recovery With Minimally Invasive Aortic Valve Surgery: A Propensity-Matched Study

Author:

Bruno Piergiorgio1,Cammertoni Federico1,Rosenhek Raphael2,Mazza Andrea1,Pavone Natalia1,Iafrancesco Mauro1,Nesta Marialisa13,Chiariello Giovanni Alfonso3,Spalletta Claudio3,Graziano Giovanni3,Sanesi Valerio3,D’Errico Denise4,Massetti Massimo13

Affiliation:

1. Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy

2. Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria

3. Catholic University of the Sacred Heart, Rome, Italy

4. Department of Cardiovascular Sciences, Perfusion Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy

Abstract

Objective Despite conflicting evidence available, minimally invasive aortic valve replacement (MIAVR) is increasingly used as an alternative to full sternotomy. We sought to compare early outcomes of aortic valve replacement through a full sternotomy (conventional aortic valve replacement [CAVR]) and upper ministernotomy (MIAVR). Methods We analyzed 297 patients having undergone primary, elective, isolated MIAVR or CAVR between January 2014 and June 2018. Following propensity score matching, 120 patients remained in each group. Results MIAVR required longer bypass (93 ± 26 vs 81 ± 24 minutes, P < 0.01) and operative times (214 ± 39 vs 182 ± 37 minutes, P < 0.01). However, aortic cross-clamp times were comparable (57 ± 17 vs 54 ± 14 minutes for MIAVR and CAVR, respectively, P = 0.14). MIAVR had less 24-hour blood loss (253 ± 204 vs 323 ± 296 mL, P = 0.03), less red blood cells transfusions [1.4 packs (1.1 o 1.9) vs 2.1 packs (1.8 to 2.7), P = 0.01], and shorter assisted ventilation time (7.1 ± 3.3 vs 9.7 ± 3.8 hours, P < 0.01) when compared to CAVR. These results led to significantly shorter intensive care unit and hospital stays for MIAVR patients (2.5 ± 1.3 vs 3.4 ± 1.1 days, P < 0.01 and 6.9 ± 4.1 vs 8.2 ± 4.8 days, P = 0.03, respectively). Thirty-day mortality and clinical outcomes did not differ significantly among groups. Conclusions MIAVR through upper ministernotomy was shown to be as safe and reliable as CAVR. Patient recovery time was improved by shortening mechanical ventilation and reducing blood loss and transfusions. These results may be significant for high-risk patients undergoing aortic valve surgery.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,General Medicine,Surgery,Pulmonary and Respiratory Medicine

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