Early Outcomes Of Minimally Invasive Aortic Valve Replacement With Rapid Deployment Bioprostheses: Insights From A National Registry
Chiara Tessari1, Augusto D'Onofrio1, Lorenzo Bagozzi1, Marco Diena2, Francesco Alamanni3, Mauro Rinaldi4, Massimo Massetti5, Ugolino Livi6, Marco Di Eusanio7, Carmelo Mignosa8, Claudio Russo9, Roberto Di Bartolomeo10, Carlo Antona11, Loris Salvador12, Daniele Maselli13, Ruggero De Paulis14, Giampaolo Luzi15, Ottavio Alfieri16, Carlo Maria De Filippo17, Marcello Portoghese18, Uberto Bortolotti19, Francesco Musumeci20, Gino Gerosa1.
1Cardiac Surgery Unit, University of Padova, Padova, Italy, 2Maggiore della Carità Hospital, Novara, Italy, 3Monzino Hospital, Milan, Italy, 4Molinette Hospital, Turin, Italy, 5Catholic University, Rome, Italy, 6Santa Maria della Misericordia Hospital, Udine, Italy, 7Ancona Hospitals, Ancona, Italy, 8Morgagni Hospital, Catania, Italy, 9Niguarda Hospital, Milan, Italy, 10Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy, 11Sacco Hospital, Milan, Italy, 12San Bortolo Hospital, Vicenza, Italy, 13S.Anna Hospital, Catanzaro, Italy, 14European Hospital, Rome, Italy, 15San Carlo Hospital, Potenza, Italy, 16San Raffaele Hospital, Milan, Italy, 17Giovanni Paolo II Foundation, Campobasso, Italy, 18Santissima Annunziata Hospital, Sassari, Italy, 19University of Pisa, Pisa, Italy, 20San Camillo-Forlanini Hospital, Rome, Italy.
BACKGROUND: Rapid-deployment (RD) aortic valve bioprostheses represent one therapeutic option for patients with severe aortic valve stenosis (AVS). Their theoretical advantages are the reduction of procedural times and the facilitation of minimally invasive operations. Aim of this retrospective multicenter study is to assess early outcomes of isolated aortic valve replacement (AVR) with RD bioprostheses performed in mini-sternotomy (MS).
METHODS: Data from a National Registry of patients who underwent AVR with RD bioprostheses were collected at each study site and anonymously sent to the coordinator center for storage and analysis. From this Registry, all patients who underwent isolated AVR using MS were selected and analyzed. Preoperative variables were defined according to the Euroscore II system and postoperative outcomes were reported according to VARC-2 definitions.
RESULTS: From December 2012 to September 2017, 326 consecutive patients underwent minimally invasive isolated AVR for severe AVS from 20 national centers. Mean age was 75±6 years and 196 (60.1%) were females. Logistic Euroscore I, Euroscore II and STS-PROM score were 6.6±5.5%, 2.0±1.3% and 2.1±1.2%, respectively. Mean CPB and ACC times were 87.1±33.2 minutes and 60.9±23.1 minutes, respectively. Peripheral cannulation were performed in 118 cases (36.2%). There were 7 conversions to full-sternotomy (2.1%) because of bleeding and 4 (1.2%) intraoperative valve-related complications (2 prosthesis replacement with a stented valve because of first prosthesis dislocations, 1 prosthesis replacement with a larger one because of incorrect sizing and 1 significant paravalvular leak requiring two surgical stitches). VARC device success was achieved in 98.8% cases. Early mortality was 1.2% (4 patients). VARC postoperative complications were 26 (8%): 2 AMIs, 3 major strokes, 20 major/life-threatening bleedings, 1 major vascular complication. New permanent pace-maker was required in 19 patients (5.8%). Postoperative echocardiography revealed a mean transprosthetic gradient of 10.9±4.5 mmHg, a mean indexed AVA of 1.15±0.3 cm2/m2 and a total of 24 (7.4%) paravalvular leaks (22 mild and 2 moderate). CONCLUSIONS: Our data suggest that RD aortic valve bioprostheses allow to perform isolated AVR using a minimally invasive approach with good perioperative clinical and hemodynamic outcomes, with a low rate of valve-related complications. However, larger studies and longer follow-up are mandatory to confirm our findings.
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