Minimally Invasive Surgery For Aortic Valve Replacement In Octogenarians Or Obese Patients
Simone Calvi, Elisa Mikus, Roberto Nerla, Antonio Micari, Marco Panzavolta, Mauro Del Giglio.
Maria Cecilia Hospital, GVM for Care & Research, Cotignola (Ra), Italy.
OBJECTIVE: Ministernotomy and right minithoracotomy for aortic valve surgery are a well-known approaches, but controversial opinions exist in high risk patients. The aim of this study is to show the potential positive role of minimally invasive surgery in octogenarian or obese patients.
METHODS: Between January 2010 and November 2016, 1875 underwent to isolated aortic valve replacement at our Institution. Of them 498 patients were older than 80 years and 462 obese (body mass index≥ 30). Surgical approach for octogenarians included standard full sternotomy (Group 1: 171), minimally invasive technique using upper J hemisternotomy (Group 2: 212) or right anterior minithoracotomy (Group 3: 115). As well obese were treated with full sternotomy (Group 1: 148), minimally invasive technique using upper J hemisternotomy (Group 2: 201) or right anterior minithoracotomy (Group 3: 113).
RESULTS: Statistical analysis shows no difference in term of intensive care unit stay for octogenarians (group 1: 69.1±104.3; group 2: 73.7±109.8; group 3: 67.8 ± 109.3, p=0.85 ANOVA one-way) and hospital stay (group 1: 9.1±8.6; group 2: 13.0±28.1; group 3: 9.2 ± 6.9, p=0.10 ANOVA one-way) and hospital mortality (3.5% vs. 2.8% vs. 3.5%, p=0.92). Similar results were obtained also for obese patients in term of ICU stay (group 1: 77.5±138.4; group 2: 67.0±130.2; group 3: 85.9 ± 228.8, p=0.61 ANOVA one-way) hospital stay (group 1: 8.9±7.1; group 2: 10.1±12.3; group 3: 9.7 ± 10.4, p=0.57 ANOVA one-way) and mortality rate (3.4% versus 1.0% versus 0%, p=0.06). For both categories of patients, operative times were statistically significant in favour of minimally invasive approaches (octogenarians: cardiopulmonary bypass time: 68±31 versus 68±20 versus 55±16 minutes, p<0.01 and cross clamp time: 52±21 versus 56 ± 18 versus 43±15, p<0.01; obese reported cardiopulmonary bypass time: 73±33 vs. 73±22 vs. 59±17, p<0.01 and cross clamp time: 58±24 vs. 60± 18 vs. 47±15, p<0.01).
CONCLUSIONS: Severe aortic valve stenosis in octogenarians or obese can be treated with minimally invasive approaches offering a biological minimally invasive surgery in terms of operative times. Thanks to a standardized technique and to a scrupulous learning curve excellent results can be offer also in high risk patients.
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