Zero 30 Day And In-hospital Mortalities In Consecutive Isolated Cardiac Valve Surgery - A Continuing Lifetime Quest Of Single Cardiac Surgeon
Takushi Kohmoto, Entela B. Lushaj.
University of Wisconsin, Madison, WI, USA.
OBJECTIVE: In the last 2 decades, minimally invasive valve surgery (MIVS) has advanced while providing improved quality, safety and patient satisfaction. However, the exact outcomes and safety of full sternotomy has not been recently revisited. The goals of our study were (1) to compare lifetime experience of single surgeon's perioperative outcomes and 30-day and in-hospital survival in patients undergoing full sternotomy or MIVS for isolated valve surgery, and (2) to establish a new benchmark when expanding transcatheter aortic valve replacement (TAVR) indication to low surgical risk population.
METHODS: Consecutive 261 isolated aortic and mitral valve surgeries were performed by single surgeon at our institution, during November 2004 - October 2016. Of those, selected 34 interventions were MIVS (lower partial sternotomy; 25 aortic valve and 9 mitral valve). Lower partial-sternotomy was chosen, because identical surgical techniques including cannulation through one incision can be achieved, and exactly same steps were taken between full sternotomy and MIVS.
RESULTS: Preoperative comorbidities were similar in two groups except for lower incidence of diabetes in MIVS group (18% vs 37%, p=0.03). OR time (hours) was shorter in MIVS (5 +/- 1 vs 6 +/- 2), although did not reach statistical significance (p=0.077). Patients undergoing MIVS had significantly shorter intubation time and hospital stay (table). Although the number in MIVS is small, there were no post-operative complications such as bleeding, infections, renal failure, and stroke in MIVS group (table). Most notably, 30-day and in-hospital mortalities were zero for both groups in this lifetime and consecutive series of single surgeon.
CONCLUSIONS: There were no 30-day and in-hospital mortalities in this series of isolated aortic and mitral valve surgeries with conventional full sternotomy or MIVS. This demonstrates low volume surgeon can achieve excellent outcomes. In carefully selected patients, MIVS improves quality and outcomes. Extremely low complication rate and mortality are needed when expanding TAVR indication to low surgical risk population.
| Full sternotomy (n=227) | MIVS (n=34) | p-value | |
| BMI | 29 +/- 6 | 28 +/- 7 | 0.893 |
| Intubation time (h) | 23 +/- 22 | 12 +/- 6 | <0.001 |
| Prolonged ventilation (>24h) | 23 (10%) | 1 (3%) | 0.186 |
| Median ICU stay (h) | 41 (24, 70) | 41 (39, 43) | 0.830 |
| Hospital stay (d) | 9 +/- 6 | 6 +/- 3 | <0.001 |
| Reop for bleeding | 5 (2%) | 0 | 0.597 |
| Wound Infection | 2 (<1%) | 0 | 0.556 |
| 30-day readmission | 21 (9%) | 2 (6%) | 0.557 |
| 30-day mortality | 0 | 0 | 1.000 |
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