Outcome Of Minimal Invasive Aortic Valve Surgery In The Era Of Transcatheter Aortic Valve Replacement
Mani Arsalan1, Florian Hecker1, Arnaud Van Linden1, Mirko Doss1, Jörg Kempfert2, Thomas Walther1.
1Kerckhoff Clinic, Bad Nauheim, Germany, 2Berlin Heart Center, Berlin, Germany.
OBJECTIVE: The indications of transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis have gradually expanded to lower risk patients. However, in contrast to surgical prosthesis, the durability of TAVR prosthesis is unknown. Minimal invasive surgical aortic valve replacement (SAVR) might be the ideal solution incorporating a small surgical access and the well-known long-term prosthesis durability.
METHODS: We retrospectively analyzed all patients undergoing minimal invasive SAVR from January 2013 to December 2015 at our institution. Transthoracic echocardiography was performed in all patient prior discharge.
RESULTS: During the study period 232 patients (102/232 female) underwent minimal invasive SAVR. The mean (± SD) age was 69y±11.2 years, pre-operative ejection fraction was 59.9±8.2%, log EuroScore was 4.4%±3.4%, EuroScore II was 1.6%±1.1%. Surgery was performed through a 6-8cm long skin incision and a J-shaped upper partial sternotomy into the 3rd or 4th intercostal space. Mean cross clamp-time was 62.2±17.8 minutes. Mean cardiopulmonary bypass time was 89.4±30.7 minutes. Conversion to full sternotomy was necessary in 2.6% (6/232) of the patients. Revision or re-exploration was performed in 6.9% (16/232) of the patients. Pre-discharge echocardiography showed a mean gradient of 14.1±5.3mmHg. Furthermore, 8.6% (20/232) of the patients had a mild aortic regurgitation, most of them (13/20) were caused by a central and not paravalvular leak. Thirty-day survival was 100%.
CONCLUSIONS: As minimal invasive SAVR can be performed safely and effectively it should be considered in all patients undergoing isolated aortic valve replacement.
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