A Randomized Multicenter Trial of Minimally Invasive Rapid Deployment Versus Conventional Full Sternotomy Aortic Valve Replacement

Borger, Michael A.; Moustafine, Vadim; Conradi, Lenard; Knosalla, Christoph; Richter, Markus; Merk, Denis R.; Doenst, Torsten; Hammerschmidt, R; Treede, Hendrik; Dohmen, Pascal M.; Strauch, Justus

doi:10.1016/j.athoracsur.2014.09.022

Cited by 180 publications

(182 citation statements)

References 26 publications

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“…[1][2][3][4][5][6][7][8][9][10] The technique utilized in our unit, i.e. J-sternotomy is also known as an upper hemisternotomy and is a routinely performed minimally invasive AVR technique in many centers.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] The more frequent use of sutureless valves along with growing expertise may be expected to result in the more frequent use of minimally invasive approaches for AVR. [8,9] Clinically, surgery performed using smaller incisions offer a number of advantages such as reduced postoperative pain and surgical trauma. [3][4][5] Also, a minimally invasive AVR appears to be superior to aortic valve surgery with a conventional sternotomy in terms of less bleeding, shorter ventilation and a reduced length of time in the intensive care unit and a shorter hospital stay.…”

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confidence: 99%

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J-sternotomy incision for aortic valve surgery: an initial experience of a tertiary care hospital

Erkanlı¹

2016

Cardiovasc Surg Int

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Objectives: This study aims to present our single-center experience of an aortic valve replacement using a minimally invasive J-sternotomy incision and to compare the early clinical outcomes of these procedures with a median sternotomy. Patients and methods:Between January 2014 and May 2015, 38 patients underwent isolated aortic valve replacement operations using a minimally invasive or a conventional sternotomy. A J-sternotomy (group JS) incision was used on 18 patients (12 males, 6 females; mean age 57.0±17.9 years; range 19 to 62 years), whereas a median sternotomy (group MS) incision was performed on 20 patients (13 males, 7 females; mean age 57.4±16.3 years; range 22 to 65 years). Preoperative characteristics, perioperative data and early outcomes were compared. Patient selection techniques, the surgical approach and our experience during the procedures were presented. Results:No mortality developed. The types (p=0.36) and dimensions (p=0.99) of implanted aortic valves were similar between the groups. There was no significant difference between the JS and MS groups in terms of cross-clamp (68.4±30.1 vs. 64.7±29.9 minutes, p=0.70) and cardiopulmonary bypass time (112.3±43.1 vs. 94.8±43.8 minutes, p=0.22). In the group JS, conversion to full sternotomy was needed in one patient due to poor surgical exposure. The lengths of intensive care unit [1.7±1.7 vs 2.2±1.2 days, (p=0.33)] and hospital [7.1±2.7 vs 7.2±1.2 days, (p=0.66)] stays were similar between the groups. A mediastinal exploration due to bleeding was performed using a full sternotomy in two patients (11.2%) from group JS. There was no significant difference in postoperative complications. Conclusion:Since it is minimally invasive for aortic valve replacement using a J-sternotomy incision is a safe and reproducible procedure. The use of a minimally invasive aortic valve replacement technique does not lead to a higher incidence of postoperative complications and associated mortality.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

J-sternotomy incision for aortic valve surgery: an initial experience of a tertiary care hospital

Erkanlı¹

2016

Cardiovasc Surg Int

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“…[16,17] High transverse aortotomy is easily achieved. Decalcification of the annulus and nadir sutures could be easily accomplished.…”

Section: [5]mentioning

confidence: 99%

Modified parasternal approach is a good alternative for aortic valve surgery

Chiu¹

2017

MIS

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Aim: Cardiac surgery, as with other surgical specialties, has moved toward minimally invasive procedures. Currently, since the cardiopulmonary bypass machine remains necessary for most cardiac surgery procedures, efforts have focused on decreasing surgical trauma by limiting vascular access sites and any unnecessary dissection. This study presents the authors' approach for less invasive valve surgery, which aimed to avoid a conventional midline sternotomy and reducing the length of incision. Methods: For patients with aortic valve involvement, parasternal approach was the primary choice. A longitudinal 5-6 cm incision was made one fingerbreadth lateral to the sternal border. The 3rd rib was cut at the chondrosternal junction and bent into the right pleural cavity. After either central aortic or peripheral cannulation, all procedures were completed under surgeon's direct vision and conventional instruments. The rib was reduced into position with a wire to offer stability and eliminate postoperative chest deformity. Results: The authors' experience of more than 500 cases with the minimally invasive approach showed that bypass time and ischemic time for parasternal valve surgery were compatible with to a full-sternotomy approach. In this series, postoperative ventilation Prof. Kuan-Ming Chiu, Vice President in Far Eastern Memorial Hospital (FEMH) and Chief of Cardiovascular Center, Taiwan. He is the Council member of the Thoracic and Cardiovascular Surgeons of Asia (ATCSA), and also serves as the Board member of several societies in Taiwan. Dr. Chiu has performed more than 5,000 cardiac operations, including over 3,000 CABG, more than 1,500 valve surgeries, and 54 heart transplants. The core competencies of his team at FEMH are in off-pump coronary artery bypass (OPCAB) and minimally invasive cardiac surgery (MICS). In August 2010, Dr. Chiu and his team initiated the Da Vinci cardiac surgery procedures and performed 52 such operations in past years. FEMH is considered a leader in endoscopic vessel harvest (EVH) procedures (more than 2,100 cases of EVH experience, including 130 endoscopic radial artery harvests) and is also a premier training center in Asia. Several foreign cardiac surgeons have been to FEMH for EVH and MICS training. More than 85% of the isolated CABG procedures he performed were OPCAB. More than 85% of valve procedures at FEMH are performed via the sternum-sparing approach (MICS). Dr. Chiu has been invited for oral presentations and live demonstrations of his OPCAB and sternum-sparing MICS techniques in Japan, China, Hong Kong, Macau, Vietnam, Malaysia, Singapore, India, Philippines and Korea. His expertise includes endoscopic mitral valve surgery, parasternal aortic valve (multivalve) surgery, and sternum sparing coronary artery bypass.

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“…This has been partly attributed to the technically more challenging nature of accessing and deploying a prosthetic aortic valve through a smaller incision. The increased complexity may prolong procedural times [4], which may increase major postoperative morbidity and mortality [7], thus reducing the benefits of the MIS approach [2]. Because MIS procedural efficiency has yet to be mastered by the general cardiovascular surgeon population, FS-AVR has remained the most frequently performed approach given its ample visibility and e xposure to the vessels.…”

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confidence: 99%

“…Conventional AVR performed via full sternotomy (FS-AVR) has been the gold standard since the 1960s and has proven to be safe and effective over time [2]. However, since a minimally invasive surgical (MIS) approach was first reported in mid-1990s, multiple studies reported several lower trauma-related benefits including decreased postoperative pain and ventilation time, less blood loss, faster sternal stability and recovery, cosmetic advantages and quicker discharge [3][4][5].…”

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confidence: 99%

The economic value of rapid deployment aortic valve replacement via full sternotomy

et al. 2017

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Aim:To compare the economic value of EDWARDS INTUITY Elite™ (EIE) valve system for rapid-deployment aortic valve replacement (RDAVR) in a full sternotomy (FS) approach (EIE-FS-RDAVR) versus FS-AVR using conventional stented bioprosthesis. Data & methods:A simulation model to compare each treatment's 30-day inpatient utilization and complication rates utilized: clinical end points obtained from the TRANSFORM trial patient subset (EIE-FS-RDAVR) and a best evidence review of the published literature (FS-AVR); and costs from the Premier database and published literature. Results: EIE-FS-RDAVR costs $800 less than FS-AVR per surgery episode attributable to lowered complication rates and utilization. Combined with the lower mortality, EIE-FS-RDAVR was a superior (dominant) technology versus FS-AVR. Conclusion: This preliminary investigation of EIE-FS-RDAVR versus conventional FS-AVR found the EIE valve offered superior economic value over a 30-day period. Realworld analyses with additional long-term follow-up are needed to evaluate if this result can be replicated over a longer timeframe.

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A Randomized Multicenter Trial of Minimally Invasive Rapid Deployment Versus Conventional Full Sternotomy Aortic Valve Replacement

Cited by 180 publications

References 26 publications

J-sternotomy incision for aortic valve surgery: an initial experience of a tertiary care hospital

J-sternotomy incision for aortic valve surgery: an initial experience of a tertiary care hospital

Modified parasternal approach is a good alternative for aortic valve surgery

The economic value of rapid deployment aortic valve replacement via full sternotomy

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