Minimally invasive versus full sternotomy aortic valve replacement in low-risk patients: Which will stand against transcatheter aortic valve replacement?

Hirji, Sameer; Funamoto, Masaki; Lee, Jiyae; Val, Fernando Ramírez Del; Kolkailah, Ahmed A.; McGurk, Siobhan; Pelletier, Marc; Aranki, Sary F.; Shekar, Prem; Kaneko, Tsuyoshi

doi:10.1016/j.surg.2018.02.018

Cited by 14 publications

(17 citation statements)

References 18 publications

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“…Thus, ILD patients may be increasingly vulnerable to the detrimental effects of prolonged operative times on postoperative pulmonary complications . Although mini‐AVR has been repeatedly shown to be safe and comparable with conventional full sternotomy AVR, it is still associated with prolonged operative times . In contrast, mini‐AVR has been shown to reduce postoperative LOS, ICU LOS, with conflicting results demonstrating possible reduction in ventilation times, which would be beneficial to ILD patients.…”

Section: Discussionmentioning

confidence: 99%

“…2 Although mini-AVR has been repeatedly shown to be safe and comparable with conventional full sternotomy AVR, it is still associated with prolonged operative times. 13,24,25 In contrast, mini-AVR has been shown to reduce postoperative LOS, ICU LOS, with conflicting results demonstrating possible reduction in ventilation times, 24,25 which would be beneficial to ILD patients. In this study, both mini-AVR and traditional full sternotomy SAVR were utilized, however, our sample size was too small to show a statistically significant benefit of one approach over the other.…”

Section: Discussionmentioning

confidence: 99%

“…Details of our fast‐track protocol and initial outcomes have been recently published . Based on the surgeon's preference, SAVR was performed using either conventional full sternotomy or via minimally invasive techniques such as hemisternotomy or right anterior minithoracotomy as previously described …”

Section: Methodsmentioning

confidence: 99%

“…CABG, coronary artery bypass grafting; ECMO, extracorporeal membrane oxygenation; ILD, interstitial lung disease; SAVR, surgical aortic valve replacement; TAVR, transcatheter aortic valve replacement; VAD, ventricular assist device on the surgeon's preference, SAVR was performed using either conventional full sternotomy or via minimally invasive techniques such as hemisternotomy or right anterior minithoracotomy as previously described. 13…”

Section: Operative Techniquementioning

confidence: 99%

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Transcatheter vs surgical aortic valve replacement in patients with interstitial lung disease

et al. 2020

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Background Patients with underlying interstitial lung disease (ILD) who undergo cardiac surgery are at high risk of postoperative pulmonary complications. It remains unclear if transcatheter aortic valve replacement (TAVR) offers any benefit over surgical aortic valve replacement (SAVR) in ILD patients with severe aortic stenosis. Methods All adult patients with a diagnosis of ILD who underwent either a TAVR or isolated SAVR between January 2002 and December 2017 were retrospectively reviewed. Operative mortality, 30‐day readmissions, and adjusted 1‐year survival were compared between the two cohorts. Results The overall cohort included 52 TAVR and 74 SAVR patients. While TAVR patients were significantly older (77.2 vs 72.9 years) with higher Society of Thoracic Surgeons predicted risk of mortality (STS‐PROM) scores compared with SAVR patients (6.29 vs 4.49; all P < .02), operative mortality was similar (5.8% vs 4.1%; P = .45). Rates of postoperative stroke, permanent pacemaker implantation, reintubation, and 30‐day readmissions did not differ between the two groups (all P > .46). However, TAVR was associated with significantly shorter hospital and intensive care unit (ICU) length of stay, shorter ventilation times, and less requirement for ICU admission (all P < .05). Thirty‐day readmissions and adjusted 1‐year survival were also similar between the two groups (hazard ratio for TAVR vs SAVR = 1.34; 95% CI: 0.7‐2.6). Conclusions Among ILD patients with symptomatic aortic stenosis, TAVR was associated with comparable operative and risk‐adjusted 1‐year survival to SAVR. TAVR patients also had shorter ventilator times, ICU and hospital stay despite being at higher risk. Together, our findings suggest that TAVR may be a better option in this unique cohort.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Operative Techniquementioning

confidence: 99%

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Transcatheter vs surgical aortic valve replacement in patients with interstitial lung disease

et al. 2020

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“…18,19 Hirji and colleagues report a single-center experience of 1,029 patients who underwent MIAVR, citing an operative mortality rate of 1.3%, a postoperative stroke rate of 2.1%, a 0.09% rate of new-onset renal failure, a 1.3% rate of reoperation for bleeding, and a mean postoperative length of stay of 6 days. 18 Our median AXC and CPB times of 53 minutes and 75 minutes, respectively, were within range of Hirji et al's reported times of 62 minutes and 81 minutes. Another group, led by Johnston and colleagues, examined a cohort of 1,193 patients who received MIAVR and report similarly favorable outcomes in their study.…”

Section: Discussionmentioning

confidence: 99%

Evolution of Minimally Invasive Surgical Aortic Valve Replacement at a Veterans Affairs Medical Center

Liang

Wisneski

Wozniak

et al. 2019

Innovations�(Phila)

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Objective The majority of minimally invasive surgical aortic valve replacements (MIAVRs) are performed at high-volume cardiac surgery centers. However, outcomes at lower volume federal facilities are not yet reported in the literature and not captured in the national Society of Thoracic Surgeons (STS) database. Our study objective was to describe the evolution of MIAVR at a Veterans Affairs Medical Center (VAMC). Methods A single-center retrospective cohort study was performed of 114 patients who underwent MIAVR for isolated aortic valvular disease between January 2011 and August 2018. Preoperative STS risk factors were determined and perioperative outcomes were analyzed. Results By 2016, 100% of isolated surgical aortic valve replacements were performed as MIAVRs at our VAMC. Introduction of automatic knot-fastening devices, single-shot del Nido cardioplegia, and rapid deployment valves decreased aortic cross-clamp (AXC) times from a median of 96 (interquartile range [IQR]: 84 to 103) to 53 minutes (38 to 61, P < 0.001, Kruskal–Wallis). Thirty-day mortality was 0.9%. Median length of hospital stay was 9 days (7 to 13). Postoperative atrial fibrillation occurred in 54% of patients, stroke occurred in 1.8% of patients, and 7.1% of patients required permanent pacemakers. Transition to rapid deployment valves decreased postoperative mean pressure gradient from median 14 mmHg (10 to 17) to 7 mmHg (4.7 to 10, P < 0.001, Mann–Whitney). At median 1.5-year follow-up echocardiogram, mean gradient was 10.8 mmHg with mild paravalvular leak rate of 1.8%. Conclusions Facilitating technologies decreased operative times during MIAVR adoption at our VAMC. For patients with isolated aortic valve pathology, MIAVR can be performed with low morbidity and mortality at lower volume federal institutions, with outcomes comparable to those reported from higher volume centers.

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Transcatheter versus surgical aortic valve replacement for severe aortic stenosis in people with low surgical risk

Kolkailah

Doukky

Pelletier

et al. 2019

Cochrane Database of Systematic Reviews

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Minimally invasive versus full sternotomy aortic valve replacement in low-risk patients: Which will stand against transcatheter aortic valve replacement?

Cited by 14 publications

References 18 publications

Transcatheter vs surgical aortic valve replacement in patients with interstitial lung disease

Transcatheter vs surgical aortic valve replacement in patients with interstitial lung disease

Evolution of Minimally Invasive Surgical Aortic Valve Replacement at a Veterans Affairs Medical Center

Transcatheter versus surgical aortic valve replacement for severe aortic stenosis in people with low surgical risk

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