Prospective Non Randomized Comparative Study Of Avr For Severe Aortic Stenosis Between Rmt And Full Sternotomy Approach In Septuagenarian
Suchart Chaiyaroj, Varissara Javakijkarnjanakul, Chawannuch Ruaengsri, Omachi Rattananont, Panuwat Leartsitthichai.
Faculty of Medicine Ramathibodi Hospital, Mahidol university, Bangkok, Thailand.
OBJECTIVE: To report early clinical results and hemodynamic performance comparing right mini thoracotomy (RMT) versus full sternotomy (FS) aortic valve replacement (AVR) for severe aortic stenosis (AS).
METHODS: 172 consecutive severe AS patients underwent isolated AVR were non-randomized prospectively reviewed during January 2003 to October 2016. Patients under 70 years old were excluded. There were 92 patients in the studies, 52 in FS group and 40 in RMT group. 92 aortic valve bovine pericardial bio-prosthesis were implanted, 70 sutured and 22 sutureless. Early clinical outcomes of 30 days mortality, stroke, prolonged ventilation, renal failure, permanent pacemaker, and echocardiographic hemodynamic performance were assessed and compared between two groups.
RESULTS: Similar results were found between RMT and FS AVR groups including age (76.08±4.97, 76.10±3.59, p = 0.8), valve sizes (21.90±2.72, 21.08±1.68, p = 0.9), aortic cross clamp time (63.33±12.21, 69.15±10.28, p = 0.3), cardiopulmonary bypass time (100.88±12.46, 107.81±12.11, p = 0.2). Early clinical results of 30 days mortality, stroke, renal failure, new pacemaker, and hemodynamic performance of aortic valve prostheses at one month, three to six month, and one year were comparable in both groups.
CONCLUSIONS: RMT approach for isolated severe AS in elderly patients is associated with cosmetic satisfaction, similar effective hemodynamic performance and comparable early clinical results to FS AVR.
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