CARDIAC SURGERY Minimally invasive aortic valve replacement – pros and cons of keyhole aortic surgery

Kaczmarczyk, Marcin; Szałański, Przemysław; Zembala, Michał; Filipiak‬, Krzysztof J.; Karolak, Wojtek; Wojarski, Jacek; Garbacz, Marcin; Kaczmarczyk, Aleksandra; Kwiecień, Anna; Zembala, Marian

doi:10.5114/kitp.2015.52850

Cited by 13 publications

(15 citation statements)

References 36 publications

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“…The long-term functional outcomes of MIAVR, including valve durability, low incidence of stroke and presence of paravalvular leak as shown in this and other studies (33,34) are excellent and comparable with the conventional AVR outcomes.…”

Section: Discussionsupporting

confidence: 71%

Long-term outcomes following minimal invasive versus conventional aortic valve replacement: a propensity match analysis

Gašparovič¹,

Artemiou²,

Hudec³

et al. 2017

BLL

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INTRODUCTION: Minimal invasive aortic valve replacement has become a routine procedure. In this study, we compared the outcomes between conventional and minimal invasive aortic valve replacement via the partial upper sternotomy that were performed in our Institution. METHODS: The 5 year survival and postoperative outcomes of 34 patients that underwent isolated MIAVR between the years 2010-2013 were compared with the outcomes of 34 randomly selected patients that underwent conventional AVR, after propensity match analysis. RESULTS: There was no difference between the two groups concerning the early and late postoperative outcomes. MIAVR patients had a longer mean cross-clamp time (p = 0.002) and longer cardiopulmonary bypass time (p = 0.0005) compared to the AVR patients. 5 year mortality and survival were 4.17 % vs 16.67 % (p = 0.20) and 95.8 % vs 83.3 % (p = 0.37) in the MIAVR and AVR groups respectively. CONCLUSION: This study showed a comparable 5 year survival and postoperative outcomes between the MIAVR and AVR groups. In our opinion, the minimal access aortic valve replacement can be performed safely with excellent long-term results in selected patients (Tab. 4, Fig. 1, Ref. 35). Text in PDF www.elis.sk. KEY WORDS: minimal access aortic valve replacement, partial upper sternotomy.

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Section: Discussionsupporting

confidence: 71%

Long-term outcomes following minimal invasive versus conventional aortic valve replacement: a propensity match analysis

Gašparovič¹,

Artemiou²,

Hudec³

et al. 2017

BLL

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“…Recently, the number of cases with aortic pathology has increased markedly, which has resulted in the search for conservative surgical treatment methods [ 1 , 2 , 3 ]. Consequently, new minimally invasive approaches (e.g., upper and lower ministernotomy; V-shaped, Z-shaped, T-shaped, J-shaped sternotomy; and other types of ministernotomy) have been introduced [ 4 , 5 , 6 ]. New ministernotomy techniques have improved the treatment and reduced the incidence of perioperative complications compared with the full sternotomy [ 2 , 3 , 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy)

et al. 2018

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Background: new minimally invasive sternotomy (mini-sternotomy) procedures have improved the treatment outcome and reduced the incidence of perioperative complications leading to improved patient satisfaction and a reduced cost of aortic valve replacement in comparison to the conventional median sternotomy (full sternotomy). The aim of this study is to compare and gain new insights into operative and early postoperative outcomes, long-term postoperative results, and 5-year survival rates after aortic valve replacement through a ministernotomy and full sternotomy. Methods: This is a retrospective study of patients who underwent an isolated replacement of the aortic valve via a full sternotomy or ministernotomy from 2011 to 2016. From 2011 to 2016, 426 cardiac interventions were performed, 70 of which (16.4%) were of the ministernotomy and 356 (83.6%) of the full sternotomy. Through propensity score matching, 70 patients who underwent the ministernotomy (ministernotomy group) were compared with 70 patients who underwent the full sternotomy (control group). Results: in the propensity matching cohort, no statistical difference in operative time was noted (p = 0.856). The ministernotomy had longer cross clamp (88.7 ± 20.7 vs. 80.3 ± 24.6 min, p = 0.007) and bypass (144.0 ± 29.9 vs. 132.9 ± 44.9 min, p = 0.049) times, less ventilation time (9.7 ± 1.7 vs. 11.7 ± 1.4 h, p < 0.001), shorter hospital stay (18.3 ± 1.9 vs. 21.9 ± 1.9 days, p = 0.012), less 24-h chest tube drainage (256.2 ± 28.6 vs. 407.3 ± 40.37 mL, p < 0.001), fewer corrections of coagulopathy (p < 0.001), fewer patients receiving catecholamine (5.71 vs. 30.0%, p < 0.001) and better cosmetic results (p < 0.001). Moreover, the number of patients without complaints at 1 year after the operation was significantly greater in the ministernotomy group (p = 0.002), and no significant differences in the 5-year survival between the groups were observed. In the overall cohort, the ministernotomy had longer cross clamp times (88.7 ± 20.7 vs. 79.9 ± 24.8 min, p < 0.001), longer operative times (263.5 ± 62.0 vs. 246.7 ± 74.2 min, p = 0.037) and bypass times (144.0 ± 29.9 vs. 132.7 ± 44.5 min, p = 0.026), lower incidence of 30-day mortality (1(1.4) vs. 13(3.7), p = 0.022), shorter hospital stays post-surgery p = 0.025, less 24-h chest tube drainage, p < 0.001, and fewer corrections of coagulopathy (p < 0.001). Conclusions: the ministernotomy has a number of advantages compared with the full sternotomy and thus could be a better approach for aortic valve replacement.

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“…Surgical replacement of the aortic valve recently offers new, minimally invasive approaches, possibly shortening the period of rehabilitation and improving the quality of life in older patients. These methods are associated with limited access (ministernotomy, minithoracotomy) or shortening of the duration of extracorporeal circulation and/or aortic cross-clamp time (sutureless valves) [ 22 ]. Gilmanov et al analyzed two propensity-matched groups of patients aged over 80 years who underwent mini-AVR (thoracotomy) and conventional sternotomy.…”

Section: Aortic Valve Replacement Surgery Resultsmentioning

confidence: 99%

Surgical treatment of elderly patients with severe aortic stenosis in the modern era – review

Kwiecień

Hrapkowicz

Filipiak‬

et al. 2018

kitp

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Surgical treatment of severe aortic stenosis offers good early and long-term results, even in elderly patients. Despite the implementation of percutaneous methods for the very high-risk group, surgical valve replacement remains the gold standard. The advanced age of patients should not be the only indicator limiting the possibility of surgery. In this review we present the most important information on the results of aortic stenosis surgical treatment in the groups of older patients. New methods such as percutaneous and minimally invasive methods of surgery are also discussed. Additionally, the presented information is referred to current guidelines for the treatment of severe aortic stenosis.

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CARDIAC SURGERY Minimally invasive aortic valve replacement – pros and cons of keyhole aortic surgery

Cited by 13 publications

References 36 publications

Long-term outcomes following minimal invasive versus conventional aortic valve replacement: a propensity match analysis

Long-term outcomes following minimal invasive versus conventional aortic valve replacement: a propensity match analysis

Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy)

Surgical treatment of elderly patients with severe aortic stenosis in the modern era – review

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