J-ministernotomy for aortic valve replacement: a retrospective cohort study

Torky, Mohammad A.; Arafat, Amr A.; Fawzy, Hosam; Taha, Abdel-Hady M.; Wahby, Ehab; Herijgers, Paul

doi:10.1186/s43057-021-00050-7

Cited by 4 publications

(2 citation statements)

References 21 publications

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“…All these data were recorded and analyzed as shown in table (4). Wound infection rates, duration of ward stay and total hospital stay were displayed in table (5). Also, post-operative echocardiography showed no trans-valvular or paravalvular leak in both groups with no difference in pressure gradients across the implanted valves.…”

Section: Resultsmentioning

confidence: 99%

“…Upper mini sternotomy via inverted T or J-shaped sternal incision has evolved as an alternative approach for AVR aiming to reduce operative trauma, ventilation requirements, bleeding, wound infection, and hospital stay (4) . However, this approach is more technically demanding owing to the associated suboptimal exposure leading to an increase in cardiopulmonary bypass (CPB) and operative times (5) . The aim of the work was to address the controversies and potential benefits of mini sternotomy compared to the full sternotomy approach in morbid obese patients undergoing isolated aortic valve replacement during the operative and hospital stay period.…”

Section: Introductionmentioning

confidence: 99%

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Mini-Sternotomy Aortic Valve Replacement in Morbid Obesity: Can The Little Offer the Greater?

Girgis

Leon

Nekhila

2022

The Egyptian Journal of Hospital Medicine

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Background: Obesity is linked to higher morbidity and death in cardiac surgery, and mini sternotomy is an established approach for aortic valve surgery (AVR). However, the use of this approach is still controversial in this group of patients.Objective: This study aimed to evaluate the potential benefits of this technique in this population. Patients and Methods: From June 2019 to June 2022, 40 morbid obese patients (body mass index ≥ 40) underwent isolated AVR surgery at the National Heart Institute. The surgical approach was median sternotomy (20 patients) and partial upper sternotomy (20 patients). Pre-, intra-, and post-operative data were gathered and analyzed. Results: Patients treated with mini sternotomy AVR had reduced post-operative ventilation time (p= 0.0001), less blood drainage (p= 0.0001), and a lower need for blood transfusion (p= 0.03). They also presented advantages in terms of shorter intensive care unit and hospital stay (p= 0.0001). However, the operative, cross-clamp, and bypass times were significantly longer (p= 0.0001) in the minimally invasive group, which can be dramatically reduced with the introduction of sutureless valves. Inotropic support, pacemaker requirement, cerebrovascular accidents, and wound infection were observed and compared between the two groups. Conclusion: Ministernotomy approach is safe for obese patients undergoing surgical AVR, offering them less biological insult and reduced incidence of postoperative complications.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mini-Sternotomy Aortic Valve Replacement in Morbid Obesity: Can The Little Offer the Greater?

Girgis

Leon

Nekhila

2022

The Egyptian Journal of Hospital Medicine

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Isolated surgical vs. transcatheter aortic valve replacement: a propensity score analysis

et al. 2023

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Background The debate about the optimal approach for aortic valve replacement continues. We compared the hospital and long-term outcomes (survival, aortic valve reintervention, heart failure readmissions, and stroke) between transcatheter vs. surgical (TAVR vs. SAVR) aortic valve replacement. The study included 789 patients; 293 had isolated SAVR, and 496 had isolated TAVR. Patients with concomitant procedures were excluded. Propensity score matching identified 53 matched pairs. Results Patients who had TAVR were significantly older (P ˂ 0.001) and had significantly higher EuroSCORE II (P ˂ 0.001), NYHA class (P ˂ 0.001), and more prevalence of diabetes mellitus (P ˂ 0.001), hypertension (P ˂ 0.001), chronic lung disease (P = 0.001), recent myocardial infarction (P = 0.002), and heart failure (P ˂ 0.001), stroke (P = 0.02), atrial fibrillation (P = 0.004), and previous percutaneous coronary interventions (P ˂ 0.001) than SAVR patients. In the matched cohort, atrial fibrillation occurred more frequently after SAVR (P = 0.01), and hospital stay was significantly longer in SAVR patients (P ˂ 0.001). There were no differences in hospital mortality between groups (P ˃ 0.99). Survival at 1, 3, and 5 years was 97%, 95%, and 94% for SAVR and 91%, 79%, and 58% for TAVR patients. Survival was lower in TAVR patients before matching (P ˂ 0.001) and after matching (P = 0.045). Freedom from the composite endpoint of stroke, aortic valve reintervention, and heart failure readmission at 1, 3, and 5 years was 98.9%, 96%, and 94% for SAVR and 94%, 86%, and 75% for TAVR. The composite endpoint was significantly higher in the TAVR group than in SVR before matching (P ˂ 0.001), while there was no difference after matching (P = 0.07). There was no significant difference in the change in ejection fraction between groups (β: −0.88 (95% CI: −2.20–0.43), P = 0.19), and the reduction of the aortic valve peak gradient was significantly higher with TAVR (β: −7.80 (95% CI: −10.70 to −4.91); P ˂ 0.001). Conclusions TAVR could reduce postoperative atrial fibrillation and hospital stay. SAVR could have long-term survival benefits over TAVR with comparable long-term stroke, heart failure readmission, and aortic valve reinterventions between SAVR and TAVR.

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The current state of minimally invasive cardiac surgery in Africa: a systematic review and meta-analysis

Akintoye,

Adu,

Otorkpa

et al. 2024

Cardiothorac Surg

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Background Globally, the utilisation of minimally invasive techniques has become increasingly prevalent. While traditional open-heart procedures still dominate the landscape, a significant portion of cardiac surgeries are now performed minimally invasively. The aim of this study is to provide an insightful overview of the current state of minimally invasive cardiac surgery in Africa. Main body A comprehensive database search was performed on PubMed, African Journal Online, Google Scholar, and Scopus to identify published data reporting on outcomes of minimally invasive cardiac surgery in Africa, from inception till June 2024. We used the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines to undergo this study. The primary outcomes of interest were in-hospital mortality and overall mortality. Data were pooled together and analysed using a random effect model for meta-analysis with R software. Out of a total of 2309 articles identified, only fourteen papers met our inclusion criteria following deduplication and screening. The four countries with published research include Egypt, South Africa, Tanzania, and Morocco, with a total sample size of 1357 patients. The meta-analysis of the reported outcomes produced a pooled in-hospital mortality prevalence of 1.18%, while the pooled overall mortality prevalence was 2.23%. There was no statistically significant difference in outcomes between the mini sternotomy and the full sternotomy group. Conclusion The pooled outcomes of minimally invasive cardiac surgery in Africa are comparable to those in other regions. However, there are several socio-economic factors limiting its widespread practice in Africa.

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J-ministernotomy for aortic valve replacement: a retrospective cohort study

Cited by 4 publications

References 21 publications

Mini-Sternotomy Aortic Valve Replacement in Morbid Obesity: Can The Little Offer the Greater?

Mini-Sternotomy Aortic Valve Replacement in Morbid Obesity: Can The Little Offer the Greater?

Isolated surgical vs. transcatheter aortic valve replacement: a propensity score analysis

The current state of minimally invasive cardiac surgery in Africa: a systematic review and meta-analysis

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