Minimally Invasive Aortic Valve Surgery in the Elderly: A Case-Control Study

Sharony, Ram; Saunders, Paul; Schwartz, Charles; Ribakove, Greg H.; Culliford, Alfred T.; Ursomanno, Patricia; Baumann, F.Gregory; Galloway, Aubrey C.; Colvin, Stephen B.

doi:10.1161/01.cir.0000087446.53440.a3

Cited by 50 publications

(64 citation statements)

References 37 publications

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“…[14e16] two studies were propensity matched [13,17] and one case control [12]. One study [14] reported amalgamated primary and secondary outcomes for minimally invasive mitral and aortic hence could not be included in the subgroup analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies [12,16,17] included specifically minimally invasive aortic valve and two studies [13,15] minimally invasive mitral surgery valve and were meta-analyzed separately. One study [14] did not separate outcomes therefore was not part of the subgroup analysis.…”

Section: Subgroup and Quality Scoring Analysismentioning

confidence: 99%

“…3). Two studies were propensity matched [13,17] and one was case control [12]; however the general level of population comparability between groups was high even in the retrospective observational studies as it is shown in the quality scoring analysis (Table 6).…”

Section: Heterogeneity Assessment: Bias Explorationmentioning

confidence: 99%

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The role of minimal access valve surgery in the elderly. A meta-analysis of observational studies

Moscarelli

Emmanuel

Athanasiou

et al. 2016

International Journal of Surgery

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h i g h l i g h t sMinimal access valve surgery is a safe alternative to the sternotomy approach in elderly patients. The approach demonstrates reduced mechanical ventilation time and reduced length of stay. Mortality is comparable to those undergoing a conventional sternotomy. Limitations for this approach include prolonged cardiopulmonary bypass and cross-clamp time.a r t i c l e i n f o b s t r a c tBackground: Minimal access valve surgery, both mitral and aortic, may be related to improvement in specific post-operative outcomes, therefore may be beneficial for the subgroup of the elderly referred for valve surgery. Methods: A systematic literature review identified several different studies, of which 6 fulfilled criteria for meta-analysis. Outcomes for a total of 1347 patients (675 conventional standard sternotomy and 672 minimally invasive valve surgery) were assessed with a meta-analysis using random effects modeling. Heterogeneity, subgroup analysis with quality scoring were also assessed. The primary endpoint was early mortality. Secondary endpoints included intra and post-operative outcomes. Results: In the context of elderly patients, minimal access valve surgery conferred comparable early mortality to standard sternotomy (odd ratio (OR) 0.79, CI [0.40,1.56], p ¼ 0.50) with no heterogeneity (p ¼ 0.13); it was also associated with reduced mechanical intubation time (OR 0.48, CI [0.30,0.78], p ¼ 0.003) and reduced post-operative length of stay (weighted mean difference (WMD) À2.91, CI [À3.09, À2.74] p < 0.00001), however both cardio-pulmonary bypass time and cross clamp time were longer (WMD 24.29, CI [22.97, 25.61] p < 0. 00001 and WMD 8.61, CI [7.61,9.61], p < 0.00001, respectively); subgroup analysis demonstrated statistically significant reduced post-operative length of stay for both minimally invasive aortic and mitral surgery (WMD À2.84, CI [À3.07, À2.60] p < 0.00001 and WMD À2.98, CI [À3.25, À2.71] p < 0.00001 respectively). Conclusions: Despite a prolonged cardiopulmonary bypass and cross clamp time, minimally invasive valve surgery is a safe alternative to standard sternotomy in the elderly, with similar early mortality, and improvements in intubation time as well as length of stay.

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Section: Resultsmentioning

confidence: 99%

Section: Subgroup and Quality Scoring Analysismentioning

confidence: 99%

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The role of minimal access valve surgery in the elderly. A meta-analysis of observational studies

Moscarelli

Emmanuel

Athanasiou

et al. 2016

International Journal of Surgery

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“…No difference in all-cause mortality has been identified between SAVR and TAVR (9,10,24,25). MiniAVR is a second option for minimally invasive management of AS and has been shown to be equivalent to and possibly better than SAVR in terms of morbidity and mortality, while decreasing blood loss, ICU and hospital length of stays and recovery time (13,19,(26)(27)(28). The main drawback is the technical difficulty and prolonged AXC and CPB times.…”

Section: Discussionmentioning

confidence: 99%

Review of minimal access versus transcatheter aortic valve replacement for patients with severe aortic stenosis

Hoffmann

Heiner

Nguyen

2017

Ann. Cardiothorac. Surg.

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Transcatheter aortic valve replacement (TAVR) and minimally invasive aortic valve replacement (miniAVR) have become alternatives to surgical aortic valve replacement via median sternotomy (SAVR) to treat severe aortic stenosis (AS). Despite increased interest and utilization, few studies have directly compared TAVR and miniAVR. A review of the current literature shows TAVR to be an indispensable tool for inoperable, high-risk, and perhaps intermediate-risk patients with severe AS. However, it is associated with a number of deleterious perioperative outcomes, such as valvular regurgitation and vascular complications. MiniAVR is associated with decreased intensive care unit (ICU) and hospital length of stay, a lower incidence of blood transfusions, decreased ventilation time, and improved cosmetic results. MiniAVR maintains potential advantages over SAVR, including the implantation of a durable prosthesis and low rates of perioperative myocardial infarction and paravalvular leak. It is associated with longer aortic cross clamp and cardiopulmonary bypass (CPB) times; however, the use of sutureless valve implants can circumvent this. Studies comparing TAVR and miniAVR demonstrate decreased postoperative mortality, valvular regurgitation, and incidence of stroke in the miniAVR cohorts. Few studies currently exist comparing TAVR and miniAVR, as it is hard to compare the typically low-risk miniAVR versus high-risk TAVR patient populations. It is clear that both strategies will be cornerstones in the modern AVR era, but the situations in which to apply each strategy have not yet been clearly delineated. This highlights the need for surgeons to adopt these minimally invasive techniques. We believe there is a compelling role for miniAVR in low-and intermediate-risk patients, but due to the paucity of data, neither TAVR nor miniAVR should be discounted before a randomized, risk-stratified trial is performed. More studies are needed to compare TAVR and miniAVR in low-and intermediate-risk patients.

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“…Comparison of minimally invasive aortic valve replacement with traditional median sternotomy technique indicated similar hospital mortality (6.9%) and morbidity (18%), with comparable actuarial survival at 3 years (85%). Furthermore, the minimal surgical approach resulted in a shorter length of stay, with a greater proportion of patients able to be discharged in a case-matched study [8].…”

mentioning

confidence: 95%