Outcomes of less invasive J-incision approach to aortic valve surgery

Johnston, Douglas R.; Atik, Fernando Antibas; Rajeswaran, Jeevanantham; Blackstone, Eugene H.; Nowicki, Edward R.; Sabik, Joseph F.; Mihaljević, Tomislav; Gillinov, A. Marc; Lytle, Bruce W.; Svensson, Lars

doi:10.1016/j.jtcvs.2011.12.008

Cited by 86 publications

(107 citation statements)

References 26 publications

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“…Johnston et al 25 reported results from 832 pairs of matched patients undergoing either cAVS or MIAVS via ministernotomy (MS) and found no difference in mortality (0.96% vs 0.96%, 95% CI, P > 0.9), stroke (1.3%, 95% CI, P > 0.9), myocardial ischemic events (0.48% vs 0.36%, 95% CI, P = 0.7), or renal failure (0.72% vs 0.84%, 95% CI, P = 0.8). The MIAVS-MS group showed superiority with significantly lower drain output at 24 hours, fewer transfusion requirements, lower pain scores, and shorter LOS (P < 0.001 for each).…”

Section: Performance Of Minimally Invasive Aortic Valve Surgerymentioning

confidence: 99%

Aortic Valve Surgery: Minimally Invasive Options

Ramlawi

Bedeir

Lamelas

2016

Methodist DeBakey Cardiovascular Journal

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Minimally invasive aortic valve surgery has not been adopted by a significant proportion of cardiac surgeons despite proven benefits. This may be related to a high learning curve and technical issues requiring retraining. In this review, we discuss the data for minimally invasive aortic valve surgery and describe our operative technique for both ministernotomy and anterior thoracotomy approaches. We also discuss the advent of novel sutureless valves and how these techniques compare to available transcatheter aortic valve procedures.

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Section: Performance Of Minimally Invasive Aortic Valve Surgerymentioning

confidence: 99%

Aortic Valve Surgery: Minimally Invasive Options

Ramlawi

Bedeir

Lamelas

2016

Methodist DeBakey Cardiovascular Journal

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“…Our literature search identified 17 relevant studies, including seven randomized controlled trials (7,8,10,(14)(15)(16)(17) and ten propensity-score matched observational studies (4,(18)(19)(20)(21)(22)(23)(24)(25)(26) (Table 1). A total of 6,516 patients were analysed, including 3,258 in the MIAVR group and 3,258 in the CAVR group.…”

Section: Quality Of Included Studiesmentioning

confidence: 99%

“…A total of 6,516 patients were analysed, including 3,258 in the MIAVR group and 3,258 in the CAVR group. Seven studies included at least 100 patients in each arm (4,(18)(19)(20)22,25,26), while ten studies included fewer than 100 patients in each arm (7,8,10,(14)(15)(16)(17)21,23,24). MS was directly compared with CS in 12 studies (7,8,10,(15)(16)(17)(18)(19)21,22,24,26), while five studies (4,14,20,23,25) directly compared MT with CS.…”

Section: Quality Of Included Studiesmentioning

confidence: 99%

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Ministernotomy or minithoracotomy for minimally invasive aortic valve replacement? A Bayesian network meta-analysis

Phan

Xie

Tsai

et al. 2015

Heart, Lung and Circulation

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Background: Establishing the relative merits of ministernotomy (MS) and minithoracotomy (MT) approaches to minimally invasive aortic valve replacement (MIAVR) is difficult given the limited available direct evidence. Network meta-analysis is a Bayesian approach that can combine direct and indirect evidence to better define the benefits and risks of MS and MT.Methods: Electronic searches were performed using six databases from their inception to June 2014.Relevant studies utilizing a minimally invasive approach for aortic valve replacement were identified. Data were extracted and analyzed according to predefined clinical endpoints. Both traditional and Bayesian metaanalysis approaches were conducted.Results: Compared to full sternotomy, MT was associated with longer cardiopulmonary bypass (CPB) duration (WMD, 9.99; 95% CI, 3.91, 16.07; I 2 =55%; P=0.001) and cross-clamp duration (WMD, 7.64; 95% CI, 2.86, 12.42; P=0.002; I 2 =74%). When compared to MS using network meta-analysis, no significant difference in duration was detected. Postoperative outcomes including 30-day mortality, stroke, and reoperation for bleeding and wound infection were comparable between MS and MT using both traditional and Bayesian meta-analysis techniques. Conclusions:The current evidence demonstrates that MIAVR via MS or MT is a safe and efficacious alternative to conventional median sternotomy. MT may be associated with longer CPB and cross-clamp durations, but has similar post-operative outcomes compared to MS. An individualized approach tailored to both the patient and surgical team is likely to provide optimal outcomes.

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“…Historically, Cosgrove and Cohn were the first clinicians to pioneer smaller incisions for both mitral and aortic procedures (1). Despite longer cardiopulmonary bypass (CPB) times compared to conventional surgery (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12), preservation of the sternal integrity and minimisation of dissection had been advocated to improve the cosmetic result, reduce bleeding, provide better respiratory function, yield shorter hospital stays and therefore lower costs and improved patient satisfaction. A large meta-analysis by Phan et al demonstrated that minimally invasive AVR (mini-AVR) is also associated with a reduced incidence of renal failure and has comparable mortality and morbidity to conventional surgery (13).…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive aortic valve replacement in high risk patient groups

Fudulu

Lewis

Benedetto³

et al. 2017

J. Thorac. Dis.

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Minimally invasive aortic valve replacement (AVR) aims to preserve the sternal integrity and improve postoperative outcomes. In low risk patients, this technique can be achieved with comparable mortality to the conventional approach and there is evidence of possible reduction in intensive care and hospital length of stay, transfusion requirement, renal dysfunction, improved respiratory function and increased patient satisfaction. In this review, we aim to asses if these benefits can be transferred to the high risk patient groups. We therefore, discuss the available evidence for the following high risk groups: elderly patients, re-operative surgery, poor lung function, pulmonary hypertension, obesity, concomitant procedures and high risk score cohorts.

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Outcomes of less invasive J-incision approach to aortic valve surgery

Cited by 86 publications

References 26 publications

Aortic Valve Surgery: Minimally Invasive Options

Aortic Valve Surgery: Minimally Invasive Options

Ministernotomy or minithoracotomy for minimally invasive aortic valve replacement? A Bayesian network meta-analysis

Minimally invasive aortic valve replacement in high risk patient groups

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