Minimally invasive access type related to outcomes of sutureless and rapid deployment valves.

Andreas, Martin; Berretta, Paolo; Solinas, Marco; Santarpino, Giuseppe; Kappert, Utz; Fiore, Antonio; Glauber, Mattia; Misfeld, Martin; Savini, Carlo; Mikus, Elisa; Villa, Emmanuel; Phan, Kevin; Fischlein, Theodor; Meuris, Bart; Martinelli, Gianluca; Teoh, Kevin; Mignosa, Carmelo; Shrestha, Malakh; Carrel, Thierry P.; Yan, Tristan; ... (2020). Minimally invasive access type related to outcomes of sutureless and rapid deployment valves. European journal of cardio-thoracic surgery, 58(5), pp. 1063-1071. Oxford University Press 10.1093/ejcts/ezaa154

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OBJECTIVES

Minimally invasive surgical techniques with optimal outcomes are of paramount importance. Sutureless and rapid deployment aortic valves are increasingly implanted via minimally invasive approaches. We aimed to analyse the procedural outcomes of a full sternotomy (FS) compared with those of minimally invasive cardiac surgery (MICS) and further assess MICS, namely ministernotomy (MS) and anterior right thoracotomy (ART).

METHODS

We selected all isolated aortic valve replacements in the Sutureless and Rapid Deployment Aortic Valve Replacement International Registry (SURD-IR, n = 2257) and performed propensity score matching to compare aortic valve replacement through FS or MICS (n = 508/group) as well as through MS and ART accesses (n = 569/group).

RESULTS

Postoperative mortality was 1.6% in FS and MICS patients who had a mean logistic EuroSCORE of 11%. Cross-clamp and cardiopulmonary bypass (CPB) times were shorter in the FS group than in the MICS group (mean difference 3.2 and 9.2 min; P < 0.001). Patients undergoing FS had a higher rate of acute kidney injury (5.6% vs 2.8%; P = 0.012). Direct comparison of MS and ART revealed longer mean cross-clamp and CPB times (12 and 16.7 min) in the ART group (P < 0.001). The postoperative outcome revealed a higher stroke rate (3.2% vs 1.2%; P = 0.043) as well as a longer postoperative intensive care unit [2 (1-3) vs 1 (1-3) days; P = 0.009] and hospital stay [11 (8-16) vs 8 (7-12) days; P < 0.001] in the MS group than in the ART group.

CONCLUSIONS

According to this non-randomized international registry, FS resulted in a higher rate of acute kidney injury. The ART access showed a lower stroke rate than MS and a shorter hospital stay than all other accesses. All these findings may be related to underlying patient risk factors.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Carrel, Thierry

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1873-734X

Publisher:

Oxford University Press

Language:

English

Submitter:

Paul Libera

Date Deposited:

14 Dec 2020 12:04

Last Modified:

14 Dec 2020 12:04

Publisher DOI:

10.1093/ejcts/ezaa154

PubMed ID:

32588056

Uncontrolled Keywords:

Aortic valve replacement Rapid deployment valve Sutureless and Rapid Deployment Aortic Valve Replacement International Registry Sutureless valve The International Valvular Surgery Study Group

BORIS DOI:

10.7892/boris.149604

URI:

https://boris.unibe.ch/id/eprint/149604

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