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OBJECTIVE: MIAVR has been practiced for a number of years, however it has been particularly adapted recently since the advent of TAVI. We investigated the outcomes following MIAVR compared to conventional aortic valve replacement (CAVR).
METHODS: 189 consecutive patients undergoing first time isolated AVR over 6 years under one surgeon were studied. Prospectively collected data were analysed on 76 patients undergoing MIAVR (partial J sternotomy) compared to 113 patients undergoing CAVR. Univariate and multivariate analyses were performed to identify predictors of outcome.
RESULTS: MIAVR were selected due to multiple high co-morbidities (median age of 77 vs. 67years, incidence of COPD 24/76(31.6%) vs. 10/113(9.7%,p0.04) and extra-cardiac arteriopathy 17/76(22.3%) vs. 7/113(6.1%) (p0.03). MIAVR had higher mean Logistic EuroSCORE 14.6% vs. CAVR 10.6%,p=0.01. Despite this there was no in-hospital mortality in the MIAVR group vs. 4.4% in CAVR,p=0.01. The incidence of COPD was 31.6% yet there were no cases of chest sepsis vs. 6.1% for CAVR,p0.02. MIAVR was associated with reduced incidence of allogenic blood transfusion(14.5% vs. 30%,p0.001), superficial wound infections (0% vs. 5.3%,p0.02) and there were no strokes. On multivariate analysis predictors for blood transfusion were increasing age(OR=2.2), prolonged bypass time(1.1) and CAVR(OR=2.3). There were no differences in the mean bypass time or cross clamp times.
CONCLUSIONS: We are increasingly using MIAVR for high-risk patients with multiple co-morbidities, especially targeting elderly patients with poor respiratory reserve. Whilst literature so far has failed to support benefits from MIAVR, there is a clear place for it. The technique works well particularly in obese patients (largest in our series 411Ibs).
Future use of this technique lends itself to sutureless valve technology and those at high risk of chest infections, bleeding diathesis and wound problems.