OBJECTIVES
To evaluate early outcomes of endoscopic aortic valve replacement and risks of concomitant procedures done through the same working port.
METHODS
At our institution we performed a data analysis of 342 consecutive patients (from July 2013 to May 2021) that underwent endoscopic aortic valve replacement with or without associated major procedure. Pre-operative, intraoperative, post-operative data were evaluated. Subsequently we perform a comparative analysis between the isolated and concomitant surgery group. The surgical access was a 3–4 cm working port in the second right intercostal space and 3 additional 5 mm mini-ports for the introduction of the thoracoscope, the transthoracic clamp and the vent line. Cardiopulmonary by-pass was achieved through peripheral cannulation.
RESULTS
105 patients (30.7%) underwent combined procedure: 2 coronary artery bypass (1.9%), 21 ascending aorta replacement (19.6%), 41 mitral surgery (38.3%), 16 mitral and tricuspid surgery (15%), 25 other procedure (27%). Death occurred in 1 patient (0.4%) in the isolated group versus 2 patients (1.9%) in the combined group (p = 0.175). Seven strokes were observed, 4 in isolated procedures (1.7%) and 3 in the concomitant ones (2.85%) (p = 0.481). Surgical revision for bleeding was performed always through the same access in 13 patients (5.4%) versus 11 patients (10.4%) (p = 0.096). Pace maker implantation was necessary in 5 patients (2.1%) versus 8 patients (7,6%) (p = 0.014). Median intubation time was 5 [2] hours versus 6 [8] (p < 0.080).
CONCLUSIONS
Through a single working port made for endoscopic aortic valve replacement a concomitant procedure may be done without affecting in-hospital mortality and post-operative stroke rate.