Right anterior mini-thoracotomy vs. conventional sternotomy for aortic valve replacement: a propensity-matched comparison

Giglio, Mauro Del; Mikus, Elisa; Nerla, Roberto; Micari, Antonio; Calvi, Simone; Tripodi, Alberto; Campo, Gianluca; Maietti, Elisa; Castriota, Fausto; Cremonesi, Alberto

doi:10.21037/jtd.2018.03.47

Cited by 25 publications

(33 citation statements)

References 16 publications

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“…[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. 7,8 When it comes to minimally invasive mitral valve repair, the results of a critical randomised controlled trial are still awaited. 9 Nevertheless, there is a general agreement in the literature, that hard end-points such as short-and long-term survival after MICS are the same with the two techniques.…”

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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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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“…Although the 3F Enable valve is no longer marketed, it was used in only 5.8% of all procedures in this analysis, and its inclusion would be unlikely to alter the findings reported here. These results are important for the modern cardiac surgeon as there is increasing demand from patients and the medical community for minimally invasive surgical approaches, particularly as these have demonstrated reductions in pain and cosmesis (21-23), while still being able to provide the same peri-operative and short term results of SAVR (24)(25)(26)(27). As treatment options increase along with patient complexity, the incorporation of a heart team into the decision making model regarding patients' suitability for surgery will help identify the most appropriate procedure on a case-by-case basis (28).…”

Section: Study 5 Study 15mentioning

confidence: 99%

“…POAF is linked to significant increases in hospital LOS (46), and patients who do not revert to sinus rhythm have increased risk of stroke and long-term mortality. Studies examining links between CPB and CC times in MiAVR cohorts have shown trends towards lower rates of POAF (27,47). This trend is amplified with the use of a sutureless valve via a minimally invasive incision, which further reduces CPB and CC times as well as POAF rates (5,48).…”

Section: Study 5 Study 15mentioning

confidence: 99%

Aortic valve replacement using stented or sutureless/rapid deployment prosthesis via either full-sternotomy or a minimally invasive approach: a network meta-analysis

Woldendorp¹,

Doyle²,

Bannon³

et al. 2020

Ann Cardiothorac Surg

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Background: New technologies such as sutureless or rapid deployment prosthetic valves and access via minimally invasive incisions offer alternatives to traditional full-sternotomy aortic valve replacement (SAVR). However, a comprehensive comparison of these surgical techniques along with alternative valve prosthesis has not been completed. Methods: Electronic databases were searched for studies comparing outcomes for SAVR, minimally invasive AVR (MiAVR), sutureless/rapid-deployment AVR (SuAVR) via full-sternotomy, or minimally invasive SuAVR (MiSuAVR) from their inception until September 2018. Early postoperative outcomes and follow-up data were included in a Bayesian network meta-analysis. Results: Twenty-three studies with 8,718 patients were identified. Compared with standard SAVR, SuAVR had significantly lower incidence of postoperative AF [odds ratio (OR) 0.33, 95% confidence interval (CI): 0.14-0.79, P=0.013] and MiSuAVR greater requirement for postoperative permanent pacemaker (OR 2.27, 95% CI: 1.25-4.14, P=0.008). All sutureless/rapid-deployment procedures had reduced cardiopulmonary bypass and cross-clamp times, by a mean of 25.9 and 25.0 min, respectively. Hospital length of stay (LOS), but not intensive care LOS, was reduced for all groups (MiAVR −1.53 days, MiSuAVR −2.79 days, and SuAVR 3.37 days). A signal towards reduced early mortality, wound infections, and acute kidney injury was noted in both sutureless/rapid-deployment and minimally invasive techniques but did not achieve significance. Sutureless/rapid-deployment procedures had favourable survival and freedom from valve related reoperation, however follow-up times were short and demonstrated significant heterogeneity between intervention groups. Conclusions: Minimally invasive and sutureless techniques demonstrate equivalent early postoperative outcomes to SAVR and may reduce ventilation time, hospital LOS and postoperative atrial fibrillation (POAF) burden.

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“…Although right anterior mini-thoracotomy (RAMT) outcomes depend on mastering MIAVR techniques, they benefit both from advancements in cardiopulmonary bypass (CPB) techniques and from the utilization of videothoracoscopic assistance; the latter adds considerable benefit to performance and procedural safety, bringing a reduction in cross-clamp times, CPB times, and ventilator support, and shorter intensive care and total hospital time [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

The First 100 Cases of Two Innovations Combined: Video-Assisted Minimally Invasive Aortic Valve Replacement Through Right Anterior Mini-Thoracotomy Using a Novel Aortic Prosthesis

Ahmad¹,

Salamate²,

Amer³

et al. 2021

Adv Ther

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Introduction: Aortic valve replacement (AVR) via right anterior mini-thoracotomy (RAMT) is less traumatic than via other surgical routes; using a novel aortic valve may confer long-term resistance against valve deterioration, and thus be useful in younger, more active patients. Here we aim to validate using the INSPIRIS RESILIA valve with minimally invasive RAMT. Methods: Between April 2017 and June 2019, 100 patients underwent video-assisted minimally invasive AVR by RAMT, using the INSPIRIS RESILIA aortic valve. Cannulation for cardiopulmonary bypass (CPB) was through femoral vessels. Clinical data were prospectively entered into our institutional database. Results: Cardiopulmonary bypass (CPB) and cross-clamping times were 79 ± 38 and 41 ± 17 min. Surgical access was successful in 100% of cases. There were no cases of intraoperative mortality, 30-day mortality, cerebrovascular events, rethoracotomy for bleeding, valve-related reoperation, right internal mammary artery injury, or conversion to sternotomy. Intensive care and hospital stays were 2 ± 1 and 6 ± 3 days, respectively. One patient had a pacemaker fitted. Postoperative dialysis was necessary in one patient. Trace to mild aortic valve regurgitation occurred in two patients. No structural valve deterioration (SVD) and paravalvular leak were seen. At 1-year follow-up mean effective orifice area (EOA) was 1.8 ± 0.1 cm 2 , peak gradient was 22.1 ± 3.1 mmHg, and mean gradient was 11.5 ± 2.3 mmHg. Conclusion:Our preliminary experience suggests that RAMT for AVR using the INSPIRIS RESILIA aortic valve is safe, effective, and reproducible. Larger studies are needed to evaluate the long-term efficacy and durability of this new valve.

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Right anterior mini-thoracotomy vs. conventional sternotomy for aortic valve replacement: a propensity-matched comparison

Abstract: Our experience shows that mini-access isolated aortic valve surgery is a reproducible, safe and effective procedure with similar outcomes and no longer operative times compared to conventional sternotomy.

Cited by 25 publications

References 16 publications

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

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

Aortic valve replacement using stented or sutureless/rapid deployment prosthesis via either full-sternotomy or a minimally invasive approach: a network meta-analysis

The First 100 Cases of Two Innovations Combined: Video-Assisted Minimally Invasive Aortic Valve Replacement Through Right Anterior Mini-Thoracotomy Using a Novel Aortic Prosthesis

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