Early Outcomes of Isolated Aortic Valve Replacement Through Right Anterior Minithoracotomy Using the Latest-Generation Biological Prosthesis

Abstract

Objective The aim of this study is to evaluate early and intermediate outcomes and hemodynamics of the latest-generation Trifecta valve implanted using right anterior minithoracotomy. Methods We performed a single-center, retrospective, observational study including 175 individuals who underwent isolated minimally invasive aortic valve replacement with the latest-generation Trifecta valves through a right anterior minithoracotomy between January 2016 and January 2019. Exclusion criteria for follow-up echocardiographic study included concomitant procedures, conversion to median sternotomy, and nonsurvival during the index admission. Analyses addressed implantation safety, 30-day and intermediate-term survival and hemodynamic performance of the valves. Results Overall, patients were followed with duration ranging from 0.5 to 3 years. Early (<30 days) mortality occurred in 2 patients (1.1%), and there were 9 (5.1%) late (>30 days) deaths. Early thromboembolic events and postoperative bleeding requiring reoperation occurred at a rate of 4.0% ( n = 7) and 6.2% ( n = 11), respectively. Overall in 175 patients who met inclusion criteria for the follow-up echocardiography study, mean gradients across all valve sizes were 41.3 ± 14.9 (standard deviation) mm Hg preoperatively and remained low at 7.2 ± 3.9 mm Hg with mean effective orifice area of 1.8 ± 0.5 cm2 on the last follow-up echo. There was 1 case of infective prosthetic endocarditis, which did not require valve explant. There were no reoperations due to valve-related problems during the study period. Conclusions This is the largest series reporting on outcomes of the latest-generation Trifecta valve implanted using right anterior minithoracotomy. Our results demonstrate that this valve can be safely implanted via a minimally invasive approach with excellent early and intermediate outcomes and hemodynamic performance.

Factores predictivos negativos para hemorragia mayor en posoperados de cambio valvular aórtico por minitoracotomía

“…Entre tanto, Gilmanov 12 , en una población de 515 pacientes sometidos a cambio valvular aórtico por minitoracotomía anterior derecha, reportó 14 de estos pacientes explorados por hemorragia mayor a lo habitual. Por último Amirjamshidi 13 , en una población de 267 pacientes, sometidos a cambio valvular aórtico por toracotomía anterior derecha, se reportó un 6.2% de exploración quirúrgica por hemorragia mayor a lo habitual remarcando que, al realizar la exploración, todos los pacientes fueron abordados por la incisión previa y no observaban sitios de sangrado activo identificables, por lo que solo se realizó hemostasia y se continuó con el cierre quirúrgico 13 . Con base en este análisis, se determinó que los autores no hacen una clasificación clara para la definición de la hemorragia mayor a lo habitual.…”

Negative predictors of major bleeding in postoperative aortic valve replacement via mini-thoracotomy

“…At the same time, Gilmanov 12 reported that out of 515 patients with aortic valve replacement via right anterior mini-thoracotomy, 14 underwent exploration due to GNB. Finally, Amirjamshidi 13 reported that 6.2% of a population of 267 patients with aortic valve replacement via right anterior thoracotomy underwent surgical exploration due to GNB, highlighting that all of the explorations were done through the previous incision and no identifiable active bleeding sites were found; therefore, only hemostasis was performed, followed by surgical closure 13 . Based on this analysis, it was determined that the authors do not provide a clear classification for defining GNB.…”