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Minimally invasive versus conventional aortic valve replacement: A propensity matched study from the UK national data
Rizwan Attia1, Graeme Hickey2, Stuart Grant2, Ben Bridgewater2, James Roxburgh1, Pankaj Kumar3, Paul Ridley4, Moninder Bhabra5, Russell Millner6, Thanos Athanasiou7, Roberto Casula7, Andrew Chukwuemka7, Thasee Pillay8, Christopher Young1.
1Guy's and St Thomas NHS foundation Trust, London, United Kingdom, 2Manchester Academic Health Science Centre, Manchester, United Kingdom, 3Morriston Hospital, Swansea, United Kingdom, 4North Staffordshire Royal Infirmary, Stoke-on-Trent, United Kingdom, 5New Cross Hospital, Wolverhampton, United Kingdom, 6Lancashire Cardiac Centre, Victoria Hospital NHS Trust, Blackpool, United Kingdom, 7Hammersmith Hospital, London, United Kingdom, 8Freeman Hospital, Freeman Hospital, United Kingdom.

OBJECTIVE: Minimally invasive aortic valve replacement (MIAVR) has been shown in numerous studies to be a safe and effective option that reduces surgical trauma and post-operative complications. It is yet underutilised and this might be to the determent of high-risk sub TAVI population patients that may benefit the most.
We aimed to evaluate outcomes of isolated minimally invasive aortic valve replacement (MIAVR) compared with conventional aortic valve replacement (CAVR).
METHODS: National Institute for Cardiovascular Outcomes Research (NICOR) data were analysed at seven volunteer centres (2006-2012). Primary outcomes were in-hospital mortality and mid-term survival. Secondary outcomes were postoperative length-of-stay (PLOS), cumulative bypass (CPB) and cross-clamp times. Propensity modelling with matched cohort analysis was employed.
RESULTS: Of 307 consecutive MIAVR patients, 151 (49%) were performed over the last two years of study with a continued increase in numbers. The 307 MIAVR patients were matched on a 1:1 ratio. In the matched CAVR group, there was no statistically significant difference in in-hospital mortality (MIAVR 4/307, 1.3%; 95%CI 0.4-3.4% versus CAVR 6/307 2.0%; 95%CI 0.8-4.3%; P=0.752). 1-year survival in the MIAVR and CAVR groups were 94.4% and 94.6%. There was no statistically significant difference in mid-term survival (P=0.677; HR: 0.90; 95%CI, 0.56-1.46). Median PLOS was lower in the MIAVR patients by 1-day (P=0.009). The mean CPB (94.8 vs.91.3 minutes; P=0.333) and cross-clamp times (74.6 vs. 68.4 minutes; P=0.006) were longer in the MIAVR group, however this was only significant in the cross-clamp time comparison.
CONCLUSIONS: MIAVR is a safe alternative to CAVR with respect to operative and 1-year mortality and is associated with a shorter post-operative length of stay. Further studies are required in high-risk (logistic EuroSCORE>10) patients to define the role of MIAVR in the treatment of patients with aortic valve disease.

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