Minimally invasive access type related to outcomes of sutureless and rapid deployment valves

Abstract

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.

Right anterior mini thoracotomy approach for isolated aortic valve replacement: Early outcomes at a Canadian center

“…Various studies have shown that RAMT AVR is associated with a low rate of postoperative complications and favorable midterm survival 19,23,24,36–46 . Our center established a minimally invasive surgical program dedicated to the sternum‐sparing RAMT approach in 2016.…”

“…There is increasing evidence that, when compared to sAVR, mis‐AVR is associated with better clinical outcomes, including reduced postoperative mortality and morbidity, shorter hospitalization, improved renal and pulmonary function, and reduced wound infection rates 15–21 . Studies have also shown mis‐AVR results in less blood transfusion, shorter assisted ventilatory time, lower stroke rates, and fewer patients with postoperative atrial fibrillation (AF) 19–33 …”

Robotic aortic valve replacement

“…In an effort focused on learning curve quality improvement, times were recorded in a protocolized manner by the operative team for each of the following robotic operative segments: aortotomy, valvectomy, annular suture placement, suture tying, and aortotomy closure. For the entire cohort, the median time (range) in minutes for each segment was 1 (1-2), 4 (1-10), 19 (15-40), 7.5 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21), and 28 (23-45), respectively.…”

“…9,10 Minimally invasive right anterior thoracotomy (RAT) also is being performed with increasing frequency, often facilitated by the use of sutureless valves. 11,12 The application of robotic assistance via an 8-cm RAT was first described in 5 patients undergoing SAVR by Folliguet in 2004. The procedure was largely abandoned, however, until recent reports of using the RAT approach to robotically facilitate initial cases of sutureless valve implantation.…”

Minimally invasive versus conventional aortic valve replacement: The network meta‐analysis

“…As experience and technology grow, 5,14 the contemporary outcomes of minimally invasive approach should be investigated.…”