Minimally invasive access type related to outcomes of sutureless and rapid deployment valves.
- Andreas M Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
- Berretta P Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy.
- Solinas M Pasquinucci Heart Hospital, Massa, Italy.
- Santarpino G Città di Lecce Hospital, GVM Care & Research, Cotignola, Italy.
- Kappert U Department of Cardiac Surgery, University Heart Centre Dresden, Dresden, Germany.
- Fiore A Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.
- Glauber M Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy.
- Misfeld M University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
- Savini C Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.
- Mikus E Cardiovascular Surgery Unit, Maria Cecilia Hospital GVM Care & Research, Cotignola, Italy.
- Villa E Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy.
- Phan K The Collaborative Research (CORE) Group, Sydney, Australia.
- Fischlein T Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany.
- Meuris B Cardiac Surgery, Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium.
- Martinelli G Cardiovascular Department, Clinica San Gaudenzio, Novara, Italy.
- Teoh K Southlake Regional Health Centre, Newmarket, ON, Canada.
- Mignosa C Department for the Treatment and Study of Cardiothoracic Diseases, Cardiothoracic Transplantation IRCCS-ISMETT, Palermo, Italy.
- Shrestha M Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
- Carrel TP Department of Cardiovascular Surgery, University Hospital, University of Bern, Bern, Switzerland.
- Yan T Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia.
- Laufer G Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
- Di Eusanio M Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy.
- 2020-06-27
Published in:
- European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - 2020
Aortic valve replacement
Rapid deployment valve
Sutureless and Rapid Deployment Aortic Valve Replacement International Registry
Sutureless valve
The International Valvular Surgery Study Group
English
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.
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.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1093/ejcts/ezaa154
- PMID 32588056
- Persistent URL
- https://sonar.ch/global/documents/327
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