Domenico Paparella1,2, Pietro Giorgio Malvindi1, Giuseppe Santarpino3,4, Marco Moscarelli5,6, Piero Guida7, Khalil Fattouch8, Vito Margari1, Luigi Martinelli9, Alberto Albertini6, Giuseppe Speziale5,6. 1. Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy. 2. Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy. 3. Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy. 4. Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany. 5. Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy. 6. Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy. 7. Maugeri Foundation, Cassano delle Murge, Bari, Italy. 8. Department of Cardiac Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy. 9. Department of Cardiac Surgery, ICLAS, GVM Care & Research, Rapallo, Italy.
Abstract
OBJECTIVES: Surgical aortic valve replacement (AVR) can be performed via a full sternotomy or a minimal access approach (mini-AVR). Despite long-term experience with the procedure, mini-AVR is not routinely adopted. Our goal was to compare contemporary outcomes of mini-AVR and conventional AVR in a large multi-institutional national cohort. METHODS: A total of 5801 patients from 10 different centres who had a mini-AVR (2851) or AVR (2950) from 2011 to 2017 were evaluated retrospectively. Standard aortic prostheses were used in all cases. The use of the minimally invasive approach has increased over the years. The primary outcome is the incidence of 30-day deaths following mini-AVR and AVR. Secondary outcomes are the occurrence of major complications following both procedures. Propensity-matched comparisons were performed based on the multivariable logistic regression model. RESULTS: In the overall population patients who had AVR had an increased surgical risk based on the EuroSCORE, and the 30-day mortality rate was higher (1.5% and 2.3% in mini-AVR and AVR, respectively; P = 0.048). Propensity scores identified 2257 patients per group with similar baseline profiles. In the matched groups, patients who had mini-AVR, despite longer cardiopulmonary bypass (81 ± 32 vs 76 ± 28 min; P = 0.004) and cross-clamp (64 ± 24 vs 59 ± 21 min; P ≤ 0.001) times, had lower 30-day mortality rates (1.2% vs 2.0%; P = 0.036), reduced low cardiac output (0.8% vs 1.4%; P = 0.046) and reduced postoperative length of stay (9 ± 8 vs 10 ± 7 days; P = 0.004). Blood transfusions (36.4% vs 30.8%; P ≤ 0.001) and atrial fibrillation (26.0% vs 21.5%, P ≤ 0.001) were higher in patients who had the mini-AVR. CONCLUSIONS: In a large multi-institutional recent cohort, minimal access approach aortic valve replacement is associated with reduced 30-day mortality rates and shorter postoperative lengths of stay compared to standard sternotomy. A prospective randomized trial is needed to overcome the possible biases of a retrospective study.
OBJECTIVES: Surgical aortic valve replacement (AVR) can be performed via a full sternotomy or a minimal access approach (mini-AVR). Despite long-term experience with the procedure, mini-AVR is not routinely adopted. Our goal was to compare contemporary outcomes of mini-AVR and conventional AVR in a large multi-institutional national cohort. METHODS: A total of 5801 patients from 10 different centres who had a mini-AVR (2851) or AVR (2950) from 2011 to 2017 were evaluated retrospectively. Standard aortic prostheses were used in all cases. The use of the minimally invasive approach has increased over the years. The primary outcome is the incidence of 30-day deaths following mini-AVR and AVR. Secondary outcomes are the occurrence of major complications following both procedures. Propensity-matched comparisons were performed based on the multivariable logistic regression model. RESULTS: In the overall population patients who had AVR had an increased surgical risk based on the EuroSCORE, and the 30-day mortality rate was higher (1.5% and 2.3% in mini-AVR and AVR, respectively; P = 0.048). Propensity scores identified 2257 patients per group with similar baseline profiles. In the matched groups, patients who had mini-AVR, despite longer cardiopulmonary bypass (81 ± 32 vs 76 ± 28 min; P = 0.004) and cross-clamp (64 ± 24 vs 59 ± 21 min; P ≤ 0.001) times, had lower 30-day mortality rates (1.2% vs 2.0%; P = 0.036), reduced low cardiac output (0.8% vs 1.4%; P = 0.046) and reduced postoperative length of stay (9 ± 8 vs 10 ± 7 days; P = 0.004). Blood transfusions (36.4% vs 30.8%; P ≤ 0.001) and atrial fibrillation (26.0% vs 21.5%, P ≤ 0.001) were higher in patients who had the mini-AVR. CONCLUSIONS: In a large multi-institutional recent cohort, minimal access approach aortic valve replacement is associated with reduced 30-day mortality rates and shorter postoperative lengths of stay compared to standard sternotomy. A prospective randomized trial is needed to overcome the possible biases of a retrospective study.
Authors: Milos M Jovanovic; Slobodan V Micovic; Miodrag S Peric; Igor S Zivkovic; Stasa D Krasic; Ognjen S Milicevic; Stefan P Stankovic; Petar M Vukovic Journal: Tex Heart Inst J Date: 2022-01-01
Authors: Domenico Paparella; Giuseppe Santarpino; Marco Moscarelli; Pietro Guida; Adriano De Santis; Khalil Fattouch; Luigi Martinelli; Roberto Coppola; Elisa Mikus; Alberto Albertini; Mauro Del Giglio; Renato Gregorini; Giuseppe Speziale Journal: Interact Cardiovasc Thorac Surg Date: 2021-07-26