Outcomes Of Aortic Valve Replacement With Two Different Surgical Approaches: A Propensity Score Matched Study.
Corazon Mabel Calle Valda, Manuel Emilio Monguió Santin, Anas Sarraj Asil, Daniel Muñoz, Nieves De Antonio Antón, Guillermo Reyes Copa.
Hospital Universitario de La Princesa, Madrid, Spain.
OBJECTIVE: Minimally invasive aortic valve surgery by way of a ministernotomy has shown excellent results in terms of mortality, morbidity, and patient satisfaction. The aim of the present study is to analyse the early and midterm outcomes after the implementation of a minimally aortic valve replacement (MIAVR) program at our institution.
METHODS: A retrospective, observational, cohort study was performed collecting data from 371 consecutive patients undergoing isolated aortic valve surgery from January 2011 to December 2015. Propensity score matching 1:1 was made based on 12 preoperative risk factors. 150 patients were selected in total (MIAVR group=75 and conventional group=75). Patients of MIAVR group in whom reconversion to full sternotomy (n=2) was required were excluded from the study.
RESULTS: No differences were found on in-hospital mortality (1.3%vs 1.3%). The ventilation time (7.4±7.3 vs 8.7±6.8), postoperative bleeding (320.4±143.7 vs 362.1±141.2), rate of major cardiovascular events (2.7% vs 4%), re-exploration for bleeding (1.3% vs 2.7%) or cardiac tamponade (1.3% vs 4%) were similar in both groups. The total length of stay was shorter in the MIAVR group (9.7±6.5 vs 13.3±8.8; p=0,006). Mean cardiopulmonary bypass time was longer in the MIAVR group (88.2±23.1 vs 81.7±17.6; p=0,03) but cross clamp time was not (64±16.2 vs 58.5±14.8; p=0.06). Median follow-up was 54.4 months [IC95% 50.6-58.1], overall survival was 85% vs 88%; Log rank x²=0.3; p=0.57 (Figure 1).
CONCLUSIONS: MIAVR can be safely implemented as a routine cardiac surgery procedure, although the operative times were significantly longer in our series. This approach is not associated with an increased rate of complications. On the other hand, total length of stay was shorter.
LEGEND: Figure1. OVERALL SURVIVAL (KAPLAN-MEIER) Overall survival: 54.4 months (CI 95% 50.6-58.1) Log rank x²=0.3; p=0.57.
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