Minimally-Invasive Aortic Valve Replacement via Right Anterior Mini-thoracotomy and Central Aortic Cannulation: A 13-Year Experience
Daniel M. Bethencourt1, Jennifer Le2, Gabriela Rodriguez3, Robert W. Kalayjian3, Gregory S. Thomas3.
1MemorialCare Heart & Vascular Institute at Long Beach and Orange Coast Memorial, Long Beach, CA, USA, 2University of California San Diego Skaggs School of Pharmacy, La Jolla, CA, USA, 3MemorialCare Heart & Vascular Institute at Long Beach Memorial, Long Beach, CA, USA.
OBJECTIVE: The study objective was to evaluate the clinical outcomes of a minimally-invasive aortic valve replacement (mini-AVR) technique by a right anterior mini-thoracotomy approach with central aortic cannulation using a 5-6 cm 2nd intercostal incision and transection of 1 (or 2) ribs.
METHODS: In this observational, 2-hospital cohort study from 2003-15, demographic and operative outcomes were evaluated, including surgical and ventilator times, length of stay, stroke, reoperation and mortality. Statistical analyses were performed using 2-tailed analyses.
RESULTS: A total of 202 patients underwent mini-AVR over 13 years, divided into 2 periods, 2003-09 (n=65, “early”) and 2010-15 (n=137, “late”). Mean age was 72.5±12.9 yrs; 60% were male. Beginning in 2006, mean cardiopulmonary bypass and aortic cross-clamp times decreased significantly each yr with Bonferroni adjustment. Demographic data were similar, except for weight, 75.3±14.7 kg early vs. 80.9±20.8 kg late (p=0.03). Compared with the early study period, late study period patients were more often extubated intra-operatively (52% vs.12%, p<0.001), had less prolonged ventilator use post-operatively (6% vs 16%, p=0.018), required less blood transfusions (mean 2.0±2.3 units vs. 3.6±3.0, p=0.011) and had shorter post-operative stay (6.3±4.5 days vs.8.0±5.9, p=0.026). Numerically, fewer post-operative strokes (1% vs. 6%, p=0.09) and fewer re-operations for bleeding (3% vs. 6%, p=0.3) occurred in the late period. In-hospital mortality did not differ, 1/65 early vs. 3/137 late.
CONCLUSIONS: Mini-AVR intra- and post-operative clinical outcomes improved over a 13-yr experience.
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