ISMICS - Safety Of Surgical Training In The Era Of Minimally-invasive Aortic Valve Replacement

Back to 2018 ePosters

Safety Of Surgical Training In The Era Of Minimally-invasive Aortic Valve Replacement
Sina Stock, Hans-Hinrich Sievers, Bence Bucsky, Doreen Richardt, Stefan Klotz.
Cardiac and Thoracic Vascular Surgery Luebeck, Luebeck, Germany.

Background Minimally-invasive surgery (MIS) is a growing subgroup in the field of cardiac surgery that has been gaining more and more importance over the last years. In line with this general trend, MIS aortic valve replacement (AVR) is considered the standard of care in many centers, though it is technically more demanding than AVR via full sternotomy. Since isolated AVR plays a central role in surgical training, this might have some impact on safety and feasibility of surgical education. This study aims to investigate if MIS AVR is safe during surgical training or if it should be reserved for experienced surgeons. Methods 730 patients underwent isolated AVR between 2010 and 2017 at our institution and were analyzed retrospectively, 609 via full sternotomy (169 by residents, 440 by attendings) and 121 via MIS (partial upper sternotomy, 32 by residents, 89 by attendings). Intraoperative details (cardiopulmonary bypass [CPB] and cross-clamp time) as well as short-term outcomes (30-day-mortality, stay on ICU, re-sternotomy due to bleeding and neurological complications) were assessed and compared in four groups: MIS AVR residents versus attendings, full sternotomy residents versus attendings, residents MIS AVR versus full sternotomy and attendings MIS AVR versus full sternotomy. Results Detailed results are displayed in Table 1.

Table 1. Results
	MIS			Full sternotomy			p (MIS versus full sternotomy)
	Residents	Attendings	p	Residents	Attendings	p	Residents	Attendings
CPB time [min]	129.2 +/- 25	101.6 +/- 42.1	0.001	116.33 +/- 26.17	100.89 +/- 33.18	< 0.001	0.011	0.885
Cross-clamp time [min]	103.8 +/- 23.5	79.2 +/- 34	< 0.001	96.08 +/- 21.21	78.51 +/- 24.66	< 0.001	0.064	0.846
Stay on ICU [days]	1.6 +/- 0.9	3 +/- 5	0.15	1.91 +/- 2.05	2.67 +/- 4.93	0.009	0.442	0.592
Re-sternotomy due to bleeding	1 (3.1%)	4 (4.5%)	0.739	9 (5.3%)	20 (4.5%)	0.686	0.6	0.983
Neurological complications	1 (3.1%)	4 (4.5%)	0.739	5 (3%)	11 (2.5%)	0.751	0.96	0.301
30-day-mortality	0 (0%)	5 (5.7%)	0.197	3 (1.8%)	7 (1.6%)	0.89	0.476	0.021

Residents had significantly longer CPB and cross-clamp times compared to attendings in MIS as well as full sternotomy AVR. When comparing intraoperative details for residents in MIS versus full sternotomy AVR, a significant difference in CPB but not in cross-clamp time was found. Considering the parameters of short-term outcome, there was no significant difference between residents and attendings in MIS as well as full sternotomy AVR except for stay on ICU, that was significantly shorter for residents performing full sternotomy AVR compared to attendings. Furthermore, there was no significant difference in short-term parameters between MIS and full sternotomy AVR in the residents group. Conclusions In this study, residents had longer CPB times when performing MIS AVR compared to full sternotomy AVR, but short-term outcome was not impaired. Thus, surgical education with MIS AVR was feasible and did not compromise patients� safety.

Back to 2018 ePosters