Mark J Russo1, Vinod H Thourani2, David J Cohen3, S Chris Malaisrie4, Wilson Y Szeto5, Isaac George6, Susheel K Kodali6, Raj Makkar7, Michael Lu8, Mathew Williams9, Tom Nguyen10, Gabriel Aldea11, Philippe Genereux12, H Kenith Fang13, Maria C Alu6, Erin Rogers8, Alexis Okoh14, Howard C Herrmann5, Samir Kapadia15, John G Webb16, Craig R Smith17, Martin B Leon6, Michael J Mack18. 1. Division of Cardiac Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey. Electronic address: mrusso@markrussomd.net. 2. Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, Georgia. 3. Clinical and Outcomes Research, St. Francis Hospital, Roslyn, New York; Cardiovascular Research Foundation, New York, New York. 4. Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 5. Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. 6. Cardiovascular Research Foundation, New York, New York; Department of Surgery, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York. 7. Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. 8. Edwards Lifesciences, Irvine, California. 9. Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York. 10. Memorial Herrmann Heart & Vascular Institute, University of Texas, Houston, Texas. 11. Department of Surgery, University of Washington, Seattle, Washington. 12. Cardiovascular Research Foundation, New York, New York; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey. 13. Division of CardioThoracic Surgery, Banner University Medical Center, Phoenix, Arizona. 14. Department of Medicine, Emory University, Atlanta, Georgia. 15. Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. 16. Centre for Cardiovascular Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada. 17. Department of Surgery, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York. 18. Department of Cardiothoracic Surgery, Baylor Scott & White Healthcare, Plano, Texas.
Abstract
BACKGROUND: Surgical aortic valve replacement can be performed through a minimally invasive (MI) or full sternotomy (FS) approach. The present study compared outcomes of MI vs FS for isolated surgery among patients enrolled in the Placement of Aortic Transcatheter Valves (PARTNER) 3 low-risk trial. METHODS: Patients with severe, symptomatic aortic stenosis at low surgical risk with anatomy suitable for transfemoral access were eligible for PARTNER 3 enrollment. The primary outcome was the composite end point of death, stroke, or rehospitalization (valve-, procedure-, or heart failure-related) at 1 year. Secondary outcomes included the individual components of the primary end point as well as patient-reported health status at 30 days and 1 year. RESULTS: In the PARTNER 3 study, 358 patients underwent isolated valve replacement at 68 centers through an MI (n = 107) or FS (n = 251) approach (8 patients were converted from MI to FS). Mean age and Society of Thoracic Surgeons score were similar between groups. The Kaplan-Meier estimate of the primary outcome was similar in the MI vs FS groups (16.9% vs 14.9%; hazard ratio, 1.15; 95% CI, 0.66-2.03; P = .618). There were no significant differences in the 1-year rates of all-cause death (2.8% vs 2.8%), all stroke (1.9% vs 3.6%), or rehospitalization (13.3% vs 10.6%, P > .05 for all). Quality of life, as assessed by the Kansas City Cardiomyopathy Questionnaire score at 30 days or 1 year, was comparable in both groups. CONCLUSIONS: For patients at low risk for isolated surgery, MI and FS approaches were associated with similar in-hospital and 1-year outcomes.
BACKGROUND: Surgical aortic valve replacement can be performed through a minimally invasive (MI) or full sternotomy (FS) approach. The present study compared outcomes of MI vs FS for isolated surgery among patients enrolled in the Placement of Aortic Transcatheter Valves (PARTNER) 3 low-risk trial. METHODS: Patients with severe, symptomatic aortic stenosis at low surgical risk with anatomy suitable for transfemoral access were eligible for PARTNER 3 enrollment. The primary outcome was the composite end point of death, stroke, or rehospitalization (valve-, procedure-, or heart failure-related) at 1 year. Secondary outcomes included the individual components of the primary end point as well as patient-reported health status at 30 days and 1 year. RESULTS: In the PARTNER 3 study, 358 patients underwent isolated valve replacement at 68 centers through an MI (n = 107) or FS (n = 251) approach (8 patients were converted from MI to FS). Mean age and Society of Thoracic Surgeons score were similar between groups. The Kaplan-Meier estimate of the primary outcome was similar in the MI vs FS groups (16.9% vs 14.9%; hazard ratio, 1.15; 95% CI, 0.66-2.03; P = .618). There were no significant differences in the 1-year rates of all-cause death (2.8% vs 2.8%), all stroke (1.9% vs 3.6%), or rehospitalization (13.3% vs 10.6%, P > .05 for all). Quality of life, as assessed by the Kansas City Cardiomyopathy Questionnaire score at 30 days or 1 year, was comparable in both groups. CONCLUSIONS: For patients at low risk for isolated surgery, MI and FS approaches were associated with similar in-hospital and 1-year outcomes.
Authors: Paul Park; Ruth Laverde; Greg Klazura; Ava Yap; Bruce Bvulani; Bertille Ki; Toussaint W Tapsoba; Emmanuel A Ameh; Maryrose Osazuwa; Michele Ugazzi; José Daza; Emma Bryce; David Cunningham; Doruk Ozgediz Journal: World J Surg Date: 2022-03-10 Impact factor: 3.352