Minimally Invasive Versus Standard Extracorporeal Circulation System In Minimally Invasive Aortic Valve Surgery: Results From 232 Patients
Paolo Berretta1, Luca Montecchiani1, Hossein M. Zahedi2, Mariano Cefarelli1, Armando Petrini3, Carlo Zingaro1, Alessandro D'alfonso1, Christopher Munch2, Marco Di Eusanio4.
1Cardiac Surgery Unit, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy, 2Cardiac Anaesthesia and Intensive Care Unit, Ospedali Riuniti, Ancona, Italy, 3Perfusion Unit, Ospedali Riuniti, Ancona, Italy, 4Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
Objective. The impact of minimally invasive extracorporeal circulation (MiECC) systems on the clinical outcomes of patients undergoing minimally invasive aortic valve replacement (MI-AVR) has still to be defined. This study compared early outcomes of MI-AVR interventions using type IV MiECC system versus conventional extracorporeal circulation (c-ECC).Methods. Data from 232 consecutive patients undergoing primary isolated MI-AVR between October 2016 and October 2018 were prospectively collected. MiECC was used in 83 (35.8%) patients and c-ECC in 149 (64.2%). The mean age of the study population was 74 ± 9.4 years (MiECC 75.1 ± 8.1 vs. c-ECC 73.2 ± 10.1; p = 0.1), and the average EuroSCORE II was 1.8 ± 1.1 (MiECC 1.8 ± 1 vs. c-ECC 1.8 ± 1.1; p = 0.9). The demographics were comparable between the groups (figure 1). Results. MiECC patients were more likely to receive rapid deployment AVR (61.4% vs. 34.2%, p < 0.001) and ultra fast track anaesthetic management (60.2% vs. 27.5%, p < 0.001). Cardiopulmonary bypass time (MiECC 76.2 min, c-ECC 77.3 min, p = 0.7) and cross-clamp time (MiECC 56.7min, c-ECC 57.9 min, p = 0.6) were similar between groups. Overall in-hospital mortality was 0.9% (n = 2), being 1.2% and 0.7% in MiECC and c-ECC, respectively (p = 0.1). Postoperative stroke occurred in 2 patients (0.9%) with no difference between groups (MiECC 0%, c-ECC 1.3%, p = 0.5). When compared with c-ECC, MiECC system was associated with reduced postoperative bleeding requiring chest re-opening (0% vs. 5.8%, p = 0.02), decreased perioperative blood product requirements (1.6 ±1.1 units vs. 2.5 ±1.8 units, p= 0.04) and shorter intensive care unit length of stay [24 hours (interquartile range: 22-46) vs. 25 hours (23-47), p = 0.04]. Conclusions.Contemporary MI-AVR yields excellent clinical outcomes with very low mortality and morbidity. In the setting of MI-AVR, MiECC system promotes ultra fast track management and provides better outcomes than c-ECC as regards bleeding and blood transfusion requirements. Thus, by reducing the surgical injury and promoting faster recovery, MiECC may further valorize MI-AVR interventions.
FIGURE LEGEND: patients' demographics and operative data 
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