ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
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Minimally Invasive Aortic Valve Reoperations As A Possible Response To Transcatheter Aortic Valve Implantation
Markus Kofler1, Lukas Stastny1, Julia Dumfarth1, Matteo Farrarini2, Antonio Miceli2, Nikolaos Bonaros1, Mattia Glauber2.
1Medical University of Innsbruck, Innsbruck, Austria, 2Istituto clinico sant' ambrogio, Milan, Italy.

Objective
Valve in valve transcatheter aortic valve implantation (TAVI) is considered to be a feasible treatment option for patients with degenerated bioprosthetic aortic valves, especially for high risk patients. Considering the increasing age of cardiac surgery survivors and the still unsolved problems of valve in valve TAVI, such as paravalvular regurgitation after surgical aortic valve replacement (AVR), the presence of high residual gradients after valve in valve TAVI and necessity of concomitant aortic surgery, alternative minimal invasive treatment strategies for high risk patients needs to be investigated further.
Therefore we retrospectively analysed the perioperative outcome of minimally invasive aortic valve reoperations in a two centre study
Methods
We prospectively included 32 patients in our study. Previous procedures were either surgical AVR (41%), coronary artery bypass grafting (28%), other valve surgery (19%) or miscellaneous (12%). Minimally invasive AVR was performed either via upper partial sternotomy (78%) or right anterior minithoracotomy (22%). Patients were investigated retrospectively in terms of operative and perioperative outcome.
Results
Median operative time was 198[141-288]min, median cardiopulmonary bypass time 115[96-136]min, median aortic cross clamp time 69[50-81]min and median hospital length of stay 8[6-9]days. Perioperative mortality and myocardial infarction was 3%. Two patients suffered from stroke. Table 1 gives an overview of detailed operative and perioperative outcome.
Conclusions
Minimally invasive redo aortic valve replacement is feasible and safe. Perioperative results are comparable to those of valve in valve TAVI with the benefit of lower postoperative transaortic gradients as compared to valve in valve TAVI.
Table 1.
Operative resultsn = 32
Operative time (min)198 [141-288]
Cardiopulmonary bypass time (min)115[96-136]
Cross clamp time (min)69[50-81]
Intubation time (hours)10[5-26]
Intensive care unit stay (hours)24[18-72]
Hospital length of stay (days)8[6-9]
Perioperative results n = 32
Mortality1(3)
Myocardial infarction1(3)
Stroke2 (6)
Renal replacement therapy1(3)
Sternal complications0 (0)
Wound infection0 (0)
Reoperation for bleeding4 (13)
Valve related reoperations0 (0)
Continuous variables are expressed as median and interquartile, caterogical variables as absolute numbers and percentages, n (%)


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