Back to Annual Meeting ePosters

OBJECTIVE:
We sought to determine the safety and efficacy of a minimally invasive right mini thoracotomy for aortic valve replacement (AVR) in patients with a previous coronary artery bypass grafting (CABG) surgery.
METHODS
We retrospectively reviewed 3436 consecutive cases from January 2005 to September 2011 to identify patients with a previous CABG surgery who subsequently underwent AVR. The outcomes of those who had minimally invasive surgery were compared with those who had a median sternotomy.
RESULTS:
Fifty-two patients were identified, of which, 28 (54%) underwent a minimally invasive approach, while 24 (46%) had a median sternotomy. The minimally invasive group consisted of 28 (100%) males, with a mean age of 76.9 ± 8.1 years, while the median sternotomy group consisted of 21 (88%) males with a mean age of 75.7 ± 6.4 years, p=0.09, p=0.38, respectively. Patients in the median sternotomy group had more diabetes mellitus (68 vs. 92%, p=0.04). Other baseline characteristics, including STS score for mortality, pre-operative creatinine, ejection fraction, hypertension, and chronic obstructive pulmonary disease, were similar in both groups.
The median aortic cross clamp (85 vs. 56 minutes, p<0.001) and cardiopulmonary bypass times (132 vs. 86 minutes, p<0.001) were longer in the minimally invasive group. One patient (3.6%) in the minimally invasive group required conversion to full re-sternotomy. The mean intensive care unit (49 vs. 69 hours, p=0.12) and total hospital length of stay (8 vs. 8, p=0.47) were similar in both groups. Fewer patients in the minimally invasive required PRBC transfusion (75 vs. 100%, p=0.009).
Composite post-operative complications occurred in 4 (14%) versus 10 (42%), p=0.03, in the minimally invasive versus the median sternotomy group. The difference in composite complications was driven by lower incidence of prolonged ventilation (7.1 vs. 38%, p=0.009) and bleeding requiring reoperation (0 vs. 13%, p=0.09) in the minimally invasive group. There was no difference in the incidence of post-operative renal failure, stroke, deep wound infection, re-intubation, or in-hospital mortality.
CONCLUSIONS:
Minimally invasive AVR via a right mini-thoracotomy in patients with previous CABG surgery can be performed safely, and may be associated with decreased post-operative complications when compared with full re-sternotomy.