Use of Adjuncts Reduce Cardiopulmonary Bypass Time During Minimally Invasive Aortic Valve Replacement
Alice Wang, Sharon L. McCartney, Judson B. Williams, Asvin Ganapathi, Donald D. Glower, Alina Nicoara, Jeffrey G. Gaca.
Duke University Medical Center, Durham, NC, USA.
Objectives: Minimally invasive aortic valve replacement (MIAVR) through a mini-thoracotomy has comparable outcomes to AVR through median sternotomy but at the cost of increased cross clamp and cardiopulmonary bypass (CPB) times. Development of adjunct technologies such as the automatic knot fastener and percutaneous retrograde coronary sinus catheter may decrease surgical times.
Methods: After IRB review, retrospective review of prospectively collected data for patients undergoing surgical AVR from 2002-2015 at a single institution was undertaken. MIAVR with adjuncts was performed on 78 patients. The automatic knot fastener was used on all patients and successful percutaneous coronary sinus catheter was placed and confirmed by transesophageal echocardiography in 67 (86%) patients. Patients were propensity matched against those who underwent a MIAVR without adjuncts (n=78) and median sternotomy (n=78) for major comorbidity. Continuous variables were compared using unpaired t-test, Wilcoxon rank sum test, and ANOVA. Categorical variables were compared using chi-squared and Fisher’s Exact Test.
Results: Patients who underwent MIAVR with adjuncts had shorter cross-clamp (70.5 vs 108.1 and 84.4 min, p< 0.0001) and CPB time (101.1 vs 166.12 and 127.7 min, p<0.0001) than patients who underwent MIAVR without adjuncts and through median sternotomy. Patients who had MIAVR with or without adjuncts received fewer blood transfusions compared to AVR through median sternotomy (0.6 and 1.2 vs 2.5, p<0.001). Patients who received MIAVR with adjuncts had similar rates of AF compared to MIAVR without adjuncts (48.7% vs 35.9%, p=0.11) but had higher rates compared to sternotomy (48.7% vs 30.8%, p=0.02). Rates of other in-hospital morbidity and mortality were similar between all groups (Table).
Conclusions: The use of adjuncts during MIAVR led to significant shortening of cross-clamp and CPB time and required fewer transfusions with similar major in-hospital morbidity and mortality compared to median sternotomy. The use of adjuncts may ameliorate previously reported operative disadvantages through a minimally invasive approach.
Table. In-hospital Outcomes
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