International Society For Minimally Invasive Cardiothoracic Surgery

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“Redo” Minimally Invasive Aortic Valve Replacement: Data From The Sutureless And Rapid Deployment International Registry
Theodor Fischlein1, Paolo Berretta2, Giuseppe Santarpino1, Utz Kappert3, Kevin Teoh4, Carmelo Mignosa5, Bart Meuris6, Giovanni Troise7, Alberto Albertini8, Thierry P. Carrel9, Martin Misfeld10, Gianluca Martinelli11, Kevin Phan12, Antonio Miceli13, Thierry Folliguet14, Malak Shrestha15, Marco Solinas16, Martin Andreas17, Carlo Savini18, Tristan Yan19, Marco Di Eusanio20.
1Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany, 2Cardiac Surgery Unit - Ospedali Riuniti, Ancona, Italy, 3Dresden Heart Center, Department of cardiac surgery, Dresden, Germany, 45Southlake Regional Health Centre, Ontario, ON, Canada, 5ISMETT/UPMC, palermo, Italy, 6Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium, 7Poliambulanza Foundation Hospital, Brescia, Italy, 8Maria Cecilia Hospital GVM Care & Research, Cotignola, Italy, 9Hospital Universitaire de Berne, Berne, Switzerland, 10University of Leipzig, Leipzig, Germany, 11Cardiovascular Department, Clinica San Gaudenzio, Novara, Italy, 12The Collaborative Research (CORE) Group, Sydney, Australia, 13Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milano, Italy, 14Henri Mondor Hospital, University of Paris, Paris, France, 15Hannover Medical School, Hannover, Germany, 16Pasquinucci Heart Hospital, Massa, Italy, 17Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria, 18Cardiac Surgery Department, Sant’Orsola Malpighi Hospital, University of Bologna, Bologna, Italy, 19Macquarie University, Sydney, Australia, 20Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy.

Objective:Re-operation (redo) for aortic valve replacement (AVR) can be a surgical challenge and is usually associated with higher risk of complications and mortality. The study aim was to report the results of a multicenter cohort of patients who underwent minimally invasive AVR (MIC-AVR) with a sutureless and rapid-deployment prosthesis in case of cardiac reoperation.Methods:From 2007 to 2017, a total of 3651 patients were collected from the Sutureless and Rapid-Deployment International Registry (SURD-IR). Out of them, 63 patients (mean age 75.3 ± 7.8 years; median Log EuroSCORE 10.1, interquartile range [IQR] 6.9-17.2) who had previously undergone cardiac surgery (58.1% AVR, 8.1% bypass surgery, 33.9% other procedure), underwent MIC-AVR and represented the study population. Preoperative, periprocedural parameters, as well as clinical outcomes, were analyzed for all patients.Results:Surgery was performed via ministernotomy in 43 patients (68.3%) and via anterior right thoracotomy in 20 (31.7%); 31 patients (49.2%) received a sutureless valve and 32 (50.8%) a rapid deployment valve. The mean cross-clamp time was 57.8 ± 23.2 min, cardiopulmonary bypass time was 95 ± 34.3 min, and4 patients (6.3%) required an associated procedure. Neither conversion to full sternotomynor in-hospital deaths occurred. Median intensive care unit stay was 1 day (IQR 1-2.5), median length of stay was 10 days (IQR 8-14). Eleven postoperative events were recorded: ischemic cerebral events in 3 patients, need for pacemaker implantation in 2 patients, bleeding requiring revision in 5, and renal insufficiency requiring dialysis in 1.On echocardiographic evaluation, one patient showed signs of paraprosthetic leak. Conclusions:Redo MIC-AVR with a sutureless and rapid-deployment prosthesisis a safe and feasible strategy, resulting in fast recovery and improved early post-operative outcome with a low complication rate.
Table 1. In-hospital outcomesLEGEND: AV: atrio-ventricular. ICU: intensive care unit. IQR: interquartile range. PM: pacemaker

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