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Minimally Invasive versus Standard Approach Aortic Valve Replacement: A Propensity Score Analysis of 808 Patients
Jochen Börgermann, MD1, Nobuyuki Furukawa, MD1, Anas Aboud, MD1, André Renner, MD1, Michael Benzinger, MD1, Kavous Hakim-Meibodi, MD1, Oliver Kuss, PhD2, Jan F. Gummert, MD1.
1Heart and Diabetes Center NRW, Bad Oeynhausen, Germany, 2Martin-Luther-University Halle, Halle / Saale, Germany.

OBJECTIVE: The proportion of minimal-invasive approaches is rising in cardiac surgery, in part driven by increasing patient demand. This study aimed to perform a risk-adjusted comparison of mortality, rate of stroke, and perioperative morbidity of aortic valve replacement conducted through either partial ministernotomy (MIC-AVR) or through conventional sternotomy (CONV-AVR).
METHODS: Between July 2009 and July 2012, data from 984 consecutive patients undergoing isolated aortic valve replacement were prospectively recorded. In 44.3% (n=436), the less invasive partial ministernotomy was used. Propensity Score matching was performed based on 15 preoperative risk factors to correct for selection bias. In-hospital mortality, stroke rate, as well as other major complications of MIC-AVR and CONV-AVR were compared in 404 matched patient pairs (total: 808).
RESULTS: Both death and rate of stroke, as well as the rates of all other complications were similar between groups (see table). Likewise, neither resource utilization (OR time, duration of stay in the intensive care unit, in-hospital stay) nor valve selection (type and size) was affected by the surgical approach.
CONCLUSIONS: Aortic valve replacement can be safely conducted through a partial ministernotomy. This approach is not associated with an increased rate of complications. Prospective studies with special emphasis on endpoints such as postoperative pain, duration of postoperative recovery, and quality of life during follow-up are needed to further clarify the role of MIC-AVR.
Results MIC-AVR vs. CONV-AVR
MIC-AVR CONV-AVROR [95%-CI]
Lethality [n (%)]4 (1.0)4 (1.0)1.00 [0.25 - 4.00]
Stroke [n (%)]4 (1.0)5 (1.2)0.80 [0.22 - 2.98]
Perioperative myocardial infarction [n (%)]2 (0.5)1 (0.3)2.00 [0.18 - 22.06]
Low output syndrome [n (%)]9 (2.2)10 (2.5)0.90 [0.37 - 2.22]
Postoperative IABP [n (%)]5 (1.2)5 (1.2)1.00 [0.29 - 3.45]
New-onset dialysis [n (%)]11 (2.7)9 (2.2)1.25 [0.49 - 3.17]
Rethoracotomy [n (%)]23 (5.7)26 (6.4)0.88 [0.50 - 1.56]


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