Minimally invasive aortic valve replacement in high risk patient groups

Fudulu, Daniel; Lewis, Harriet; Benedetto, Umberto; Caputo, Massimo; Angelini, Gianni; Vohra, Hunaid A.

doi:10.21037/jtd.2017.05.21

Cited by 25 publications

(21 citation statements)

References 71 publications

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“…MiAVR has shown reductions in pain, mechanical ventilation, blood transfusion requirement, sternal wound complications, atrial fibrillation and hospital length of stay (LOS) when compared to SAVR via complete sternotomy (2)(3)(4)(5). The clinical applicability of MiAVR has expanded from low-risk patients into higher risk cohorts as improved postoperative outcomes have been demonstrated (6). TAVI can likewise be performed via several access routes, including femoral, axillary and carotid arteries.…”

Section: Introductionmentioning

confidence: 99%

Minimally-invasive versus transcatheter aortic valve implantation: systematic review with meta-analysis of propensity-matched studies

Doyle

Woldendorp

et al. 2021

J Thorac Dis

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Background: Minimally invasive aortic valve replacement (MiAVR) and transcatheter aortic valve implantation (TAVI) provide aortic valve replacement (AVR) by less invasive methods than conventional surgical AVR, by avoiding complete sternotomy. This study directly compares and analyses the available evidence for early outcomes between these two AVR methods. Methods: Electronic databases were searched from inception until August 2019 for studies comparing MiAVR to TAVI, according to predefined search criteria. Propensity-matched studies with sufficient data were included in a meta-analysis. Results: Eight studies with 9,744 patients were included in the quantitative analysis. Analysis of riskmatched patients showed no difference in early mortality (RR 0.76, 95% CI, 0.37-1.54, P=0.44). MiAVR had a signal towards lower rate of postoperative stroke, although this did not reach statistical significance (OR 0.42, 95% CI, 0.13-1.29, P=0.13). MiAVR had significantly lower rates of new pacemaker (PPM) requirement (OR 0.29, 95% CI, 0.16-0.52, P<0.0001) and postoperative aortic insufficiency (AI) or paravalvular leak (PVL) (OR 0.05, 95% CI, 0.01-0.20, P<0.0001) compared to TAVI, (OR 0.42, 95% CI, 0.13-1.29, P=0.13), while acute kidney injury (AKI) was higher in MiAVR compared to TAVI (11.1% vs. 5.2%, OR 2.28, 95% CI, 1.25-4.16, P=0.007). Conclusions: In patients of equivalent surgical risk scores, MiAVR may be performed with lower rates of postoperative PPM requirement and AI/PVL, higher rates of AKI and no statistical difference in postoperative stroke or short-term mortality, compared to TAVI. Further prospective trials are needed to validate these results.

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Section: Introductionmentioning

confidence: 99%

Minimally-invasive versus transcatheter aortic valve implantation: systematic review with meta-analysis of propensity-matched studies

Doyle

Woldendorp

et al. 2021

J Thorac Dis

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“…Minimally invasive approaches reduced the amount of blood loss, probability of infection and hospitalization duration; improved cosmetic results; and accelerated patient recovery [ 10 , 11 , 12 , 13 ]. Despite the numerous advantages inherent to minimally invasive techniques, some authors have noted several negative effects, such as longer aortic cross-clamp and cardiopulmonary bypass times [ 12 , 13 , 14 ], which could in turn influence surgery performance and could be an unfavorable factor for patients of advanced age [ 15 , 16 ]. Moreover, some studies have explored short-term survival outcomes of minimally invasive techniques as compared with those of full sternotomy.…”

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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“…Studies, mostly observational, have shown potential benefits in terms of increased patient satisfaction, reduced wound infections, improved postoperative respiratory function, faster recovery, reduced blood transfusions and improved cost-effectiveness with MICS when compared to conventional approaches. [1][2][3] However, recently published randomised trials comparing mini-sternotomy aortic valve replacement (AVR) with conventional AVR have shown no clear benefit. [4][5][6] Randomised data looking at the potential benefits of mini-thoracotomy AVR are still awaited; however, some observational studies have shown that this holds a promise.…”

Section: Overviewmentioning

confidence: 99%

Minimally invasive cardiac valve surgery during the COVID-19 pandemic: to do or not to do, that is the question

2020

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Minimally invasive aortic valve replacement in high risk patient groups

Cited by 25 publications

References 71 publications

Minimally-invasive versus transcatheter aortic valve implantation: systematic review with meta-analysis of propensity-matched studies

Minimally-invasive versus transcatheter aortic valve implantation: systematic review with meta-analysis of propensity-matched studies

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

Minimally invasive cardiac valve surgery during the COVID-19 pandemic: to do or not to do, that is the question

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