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Redo Minimally Invasive Aortic Valve Replacement Shortens Hospital Stay compared to Redo Conventional Aortic Valve Replacement
Kayven Farshad, Stephen J. Kaplan, Christopher Piercecchi, Samata R. Paidy, Robert S. Poston, Sreekumar Subramanian.
University of Arizona Medical Center, Tucson, AZ, USA.

Background: In recent years, redo minimally invasive (partial upper) sternotomy has been increasingly used. However, the approach is technically more challenging and may be associated with longer operative times. The purpose of this study was to determine whether the redo minimally invasive approach confers any advantages over conventional redo sternotomy for isolated aortic valve replacement.
Methods: Between March 2011 and October 2012, 27 consecutive patients underwent redo procedures for isolated aortic valve replacement and were divided into 2 groups. Surgical approach for Group 1 patients was conventional redo sternotomy, and a redo mini-sternotomy for Group 2 patients. Retrospective chart review was used to analyze indications, techniques and outcomes. Statistical comparison was performed using t-test, Mann- Whitney and Fischer’s exact test, where appropriate.
Results: Group 1 patients (12/27, 44%) received a full sternotomy, while Group 2 patients (15/27, 56%) were treated via mini-sternotomy. Demographics, operative details and outcome data are presented in Table 1. Despite being much older, Group 2 patients (redo mini-sternotomy) had a significantly lower post-procedure length of stay (p=0.02) than Group 1 patients, a difference which persisted after exclusion of infective endocarditis cases. In-hospital and 30-day mortality was 0% for both groups.
Conclusions: Compared to conventional redo sternotomy, the redo minimally invasive (partial upper) sternotomy shortens the post-procedure hospital stay, and should be considered for patients ineligible for transcatheter aortic valve implantation.
Table 1.
AllGroup 1Group 2p-value
n271215
Age, years (IQR)70 (47-75)49 (42-72)73.5 (69.5-78)0.006*
Sex, female (%)5 (19%)3 (20%)2 (17%)> 0.99
Preoperative creatinine, mg/dL (IQR)1.1 (0.9-1.4)1.1 (0.9-1.4)1.05 (0.85-1.4)0.71
Urgent status, No. (%)3 (11%)2 (13%)1 (8%)> 0.99
Chronic lung disease present, No. (%)5 (19%)2 (13%)3 (25%)0.63
Active endocarditis, No. (%)5 (19%)4 (27%)1 (8%)0.34
Perfusion time, minutes (sd)^120.1 (39.2)106.5 (32.7)137.1 (41.3)0.04*
Cross clamp time, minutes (sd)^80.7 (24.4)74.9 (25.6)88.0 (21.6)0.17
Total operating room time, minutes (sd)^388.2 (89.9)397.6 (98.3)376.4 (81.0)0.55
Surgical time, minutes (sd)^288.0 (77.0)290.5 (85.4)285.0 (68.8)0.86
Maximum postoperative creatinine, mg/dL (IQR)1.2 (1.0-1.7)1.2 (1.1-2.2)1.1 (1.0-1.6)0.23
Intraoperative RBC, units1 (0-4)1 (0-3)2 (1-4)0.27
Postoperative RBCs, units0 (0-1.5)0 (0-0)1 (0-3)0.12
Postoperative prolonged ventilator use, No. (%)4 (15%)2 (13%)2 (17%)> 0.99
Postoperative renal failure, No. (%)3 (11%)2 (13%)1 (8%)> 0.99
Post-procedure length of stay, days (IQR)8 (4-11)9 (5-15)4 (3-8.5)0.01*
Total length of stay, days (IQR)9 (4-18)10 (6-20)4 (3-11)0.02*
30-day mortality, No. (%)0 (0%)0 (0%)0 (0%)> 0.99
In patients without infective endocarditis
Post-procedure length of stay, days (IQR)5 (4-10)8 (5-15)4 (3-8)0.02*
Total length of stay, days (IQR)6 (4-13)9 (6-18)4 (3-9)0.02*
* p-value < 0.05
^ T-test


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