Redo Aortic Valve Surgery In Minimally Invasive Approach: Preliminary Results
Theodor Fischlein, Joachim Sirch, Giuseppe Santarpino.
Klinikum Nürnberg - Paracelsus Medical University, Nuremberg, Germany.
OBJECTIVE: “Redo“ aortic valve surgery is often a surgical challenge with many described strategy to reduce intraoperative or postoperative complications, since even to avoid the operation (e.g. TAVI). Recently we have been performing these “Redo” procedures in minimally invasive approach.
METHODS: Since 2010, a total of 162 patients underwent a “Redo” procedure (first procedure: aortic valve replacement performed via full-sternotomy). Among these, 31 patients re-treated with J-sternotomy (PARTIAL) were compared with 131 patients who had undergone cardiac surgery with a “new” full-sternotomy (FULL).
RESULTS: We recorded not significantly differences between the two group for the preoperative clinical risk factors and characteristics. Cardiopulmonary bypass time, cross-clamp time and operation time were not different between the two groups, tendency shorter in the minimally invasive procedure, in particular: FULL 117, 74 and 235 minutes; PARTIAL 101, 68 and 202 minutes, respectively (p=0.08, 0.23, 0.09). In-hospital mortality did not significantly differ between patients who underwent full or partial sternotomy (18-13.7% vs 3-9.7%; p=0.77). Similarly, postoperative complications were comparable between groups (Stroke: FULL 3-2.3% vs PARTIAL 0, p=1; Dialysis: FULL 25-19.1% vs PARTIAL 4-12.9%, p=0.6; wound complications: FULL 20-15.3% vs PARTIAL 1-3.2%; p=0.08). Postoperative “steps” were faster in the minimally invasive group, but only the hospitalization time showed a statistical advantage: intubation time, FULL 74 hours vs PARTIAL 61 hours, p=0.77; ICU-stay FULL 6.8 days vs PARTIAL 3.6 days, p=0.06; Hospital-Stay FULL 19 days vs PARTIAL 15 days, p=0.025. Partial Sternotomy patients recorded few drainage losses and few need of transfusion, but without a statistical significance: Drain FULL 624 mL vs PARTIAL 466 mL, p=0.62; Blood FUL 2.0 units vs PARTIAL 1.3 units, p=0.55; Plasma FULL 2.3 units vs PARTIAL 1.0 Units, p=0.05; Platelets FULL0.7 units vs PARTIAL 0.4 units, p=0.09.
CONCLUSIONS: Minimally invasive “redo” aortic valve surgery is a safe and not time demanding procedure. Our results demonstrate possible clinical advantages, especially in terms of need of transfusions, wound complications and duration of hospitalization.
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