A real-world practice multicenter in-hospital outcomes in 2609 consecutive patients underwent mini- vs full-sternotomy aortic valve replacement: A propensity match analysis.
Khalil Fattouch, MD1, Pietro Dioguardi, MD1, Alberto Albertini, MD2, Renato Gregorini, MD3, Giuseppe Nasso, MD4, Roberto Coppola, MD5, Giuseppe Speziale, MD6, Mauro Del Giglio, MD2.
1Maria Eleonora Hospital, Palermo, Italy, 2Maria Cecilia Hospital, Cotignola, Italy, 3Citta' di Lecce Hospital, Lecce, Italy, 4Anthea Hospital, Bari, Italy, 5ICLAS - Istituto Clinico Ligure di Alta SpecialitÓ, Rapallo, Italy, 6Anthea Hospital, Bari, Italy.
OBJECTIVE: The minimally invasive approaches for aortic valve replacement (AVR) is growing due to patients require and better surgical management. Nowadays, early outcomes of patients underwent isolated AVR are excellent but it is still debated if this results must be achieved by minimally invasive access. We report our real-world practice multicentre early results of the AVR through mini- vs full-sternotomy.
METHODS: Between January 2010 and December 2013, 2609 consecutive patients underwent isolated AVR in 6 institutions. There were 1782 patients underwent full sternotomy and 827 mini-sternotomy. A non-parsimonious multiple logistic regression analysis was used to built the propensity score. Therteen parameters were used for matching process. With propensity score matching, 767 patients (min-sternotomy) were compared with 767 patients in conventional sternotomy (control group). Mean age was 71.1 ± 18.3 years (range was 21-91 years). Mean EUROscore was 6.48 ± 2.53.
RESULTS: After propensity matching, both groups were comparable in terms of preoperative characteristics. Aortic cross-clamping and cardiopulmonary bypass time were 62.71 ± 22.88 vs 61.83± 21.36 minutes (p=0.18)and 77.1 ± 30.06 vs 78.47± 28.7 min (p=0.45), respectively. Difference was found in length of in hospital stay, 12.48± 10.1 vs 11.28± 9.3 (p=0.001), revision for bleeding 2.6%vs3.9% (p=0.02), sternal revision 1% vs 2.3% (p=0.009). No difference was found in the incidence of blood transfusion, atrial fibrillation, stroke, perioperative AMI, and others postoperative complications. Overall in-hospital mortality was 2.2% vs 2.1%, respectively. Reduction in total postoperative complications was observed in mini-sternotomy group.
CONCLUSIONS: Aortic valve replacement can be securely carried out through a partial upper sternotomy. Our experience shows that this approach offers an excellent in-hospital survival associated with low rate of complications, and may be performed widely and safely in multicenter by different surgeons.
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