Clinical Outcomes Of Minimal Access Aortic Valve Replacement Using J-sternotomy In Octogenarians
Joseph George, Sobaran Sharma, Yasir Ahmed, Umair Aslam, Prakash Nanjaiah, Pankaj Kumar.
Morriston Hospital, Swansea, United Kingdom.
Background: Aortic valve stenosis is the most common acquired valve lesion among octogenarians in the Western societies. The UK octogenarian population is set to double from 2.5 million currently to 5 million by 2030. Partial sternotomy aortic valve replacement (mini-AVR) leads to reduced surgical morbidity, reduced blood transfusion requirements, less post-operative pain and quicker recovery by maintaining sternal integrity. We assessed the clinical outcomes of the mini-AVR undertaken in our octogenarian population.
Methods: All patients undergoing isolated aortic valve replacement by partial J-sternotomy were extracted from a prospectively entered database between 2006 and 2017. Patient demographics, pre-morbid status, operative details and outcomes were evaluated.
Results: 251 mini-AVRs were undertaken between Mar 2006 and Dec 2017, out of which 64 patients (26%) were aged 80 or above. The mean age was 84 years (range 80-91 SD 3), female 63%, diabetes mellitus 10%, pulmonary disease 22%, poor LV function in 7%, moderate in 17% and good LV in 76% of the cases. Logistic EuroSCORE was 13.3 (interquartile range 8-15, SD 9). Overall in-hospital and 30-day mortality, stroke, re-exploration rate, conversion to full sternotomy was 0%. Renal failure requiring dialysis was 1.6% (1/61), and permanent pacemaker rate was 1.6%.
Conclusion: Despite high logistic Euro SCORE and high predicted operative risk, we have shown excellent results in octogenarians by this approach. In this era of transcatheter aortic valve implantation, mini-AVR adds to the armamentarium of the surgical team when evaluating the intervention options for severe aortic stenosis in the octogenarian population.
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