Is aortic valve replacement with a minimally invasive extracorporeal circuit a contemporary option for octogenarians?

Abstract

<jats:title>Abstract</jats:title> <jats:p /> <jats:sec> <jats:title>OBJECTIVES</jats:title> <jats:p>Minimally invasive extracorporeal circuits have been introduced to cardiac surgery in an attempt to reduce the negative effects of cardiopulmonary bypass on patient outcome. On the other hand, transcatheter aortic valve replacement (TAVR) provides an excellent option to replace the aortic valve without the need for cardiopulmonary bypass. Several studies have compared TAVR to surgical aortic valve replacement (SAVR) but none have utilized a minimally invasive extracorporeal circuit.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>We retrospectively analysed the results of both procedures among octogenarians operated in our department from 2003 to 2016. Excluded were patients with an active endocarditis, a history of previous cardiac surgery, as well as those who had a minimally invasive surgical approach. This yielded 81 and 142 octogenarians in the SAVR and TAVR groups, respectively. To compensate for a lack of randomization, we performed a propensity score analysis, which yielded 68 patient pairs for the final analysis.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The 30-day postoperative mortality was lower in the SAVR group (1.5% vs 5.9%) but not statistically significant (P = 0.4). In contrast, the incidence of postoperative atrial fibrillation was lower in the TAVR group (13% vs 29%) but also non-significant (P = 0.2). Finally, the incidence of paravalvular leakage was in favour of the SAVR group (2.9% vs 52%; P = 0.001) while the transfusion requirement was significantly lower in the TAVR group (29% vs 72%; P &amp;lt; 0.001).</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>SAVR utilizing a minimally invasive extracorporeal circuit improves the quality of patient care and can offer an alternative to TAVR in octogenarians.</jats:p> </jats:sec>

2021 MiECTiS focused update on the 2016 position paper for the use of minimal invasive extracorporeal circulation in cardiac surgery

“…This study confirmed previous results from other large series of patients undergoing complex procedures, which also showed 100% technical feasibility and a low cumulative conversion rate of 2%. 9,10,55 In light of this data, we can postulate that use of modular (type IV) MiECC secures safety and ensures technical feasibility in all cardiac surgical procedures. Modular configuration permits immediate conversion to an open circuit; thus, it ultimately creates a "safety net" that eliminates any safety concern regarding air handling and volume management, while it overcomes any unexpected intraoperative scenario.…”

“…This study confirmed previous results from other large series of patients undergoing complex procedures, which also showed 100% technical feasibility and a low cumulative conversion rate of 2%. 9,10,55…”

“…56 Surgical results were comparable in this population to transcatheter aortic valve replacement (TAVR). 55 Even in less elderly populations (>75 years) positive results in terms of clinical outcome have been identified. 58…”

“…56 Surgical results were comparable in this population to transcatheter aortic valve replacement (TAVR). 55 Even in less elderly populations (>75 years) positive results in terms of clinical outcome have been identified. 58 As far as high-risk groups are concerned, a single study showed incremental benefit with MiECC in the treatment of dialyzed patients.…”