Predictors Of Mortality Following Minimally Invasive Aortic Surgery. Single Centre Experience.
Jakub Staromlynski1, Mariusz Kowalewski1, Anna Witkowska1, Radoslaw Smoczynski1, Wojciech Sarnowski1, Maciej Bartczak1, Dominik Drobinski1, Leszek Markuszewski2, Marcin Maruszewski1, Piotr Suwalski1.
1Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland, 2Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland.
Background: Minimally invasive aortic valve (AV) surgery has become widely accepted alternative to standard sternotomy approach for the treatment of AV disease. Despite possible reduction in morbidity, this approach is not routinely performed for aortic replacements though. The objective of the current report was to report predictors of mortality in patients undergoing minimally invasive aortic root- and ascending aorta- replacements. Material and methods: Between 2011 and 2018, 167 selected low- and intermediate risk patients (mean age: 64.1±11.3; 70.1% men; EuroSCORE II 2.58±3.26) underwent minimally invasive aortic surgery. Redo-surgeries, endocarditis cases and acute dissections were excluded. The "J" or "V" shaped partial upper sternotomy was performed through a 6-cm skin incision from the notch to the third or fourth intercostal space depending on surgeons' preference. Predictors of cumulative mortality were identified by logistic regression taking into account 3 groups of variables: baseline clinical characteristics, operative data and early complications. Coefficients along with 95% confidence intervals (CI) are reported. Results: Mean follow-up was 3.1 year (max 7.7 years). Of 167 patients, 82 (49.1%) underwent supracoronary aortic replacement surgery; 44 (26.3%) with concomitant AVR. Forty-one patients (24.5%) underwent minimally invasive aortic root surgery. Average aortic diameter was 6.00±0.46cm. Thirty-day mortality was 0.6% and remote survival was estimated at 94.7%. Of all analysed variables, strongly predictive of mortality were COPD (2.03 [0.31-3.75]; p=0.020); higher EuroSCORE (0.18 [0.02-0.35]; p=0.028); lower LVEF (-0.09 [-0.17, -0.03); p=0.003) and longer duration of CPB (0.03 [0.01-0.05]; p=0.043). No significant relationships were demonstrated for presence of arterial or pulmonary hypertension, diabetes, coronary or kidney disease, the type of surgery (valve sparing vs non-valve sparing), type of valve prosthesis, length of ICU stay, transfusions and complications including need for ECMO, IABP, CVVH, bleeding and reoperations. Conclusions: Low ejection fraction, higher EuroSCORE, longer CPB and presence of COPD are strong predictors of mortality after aortic surgery performed in a minimally invasive fashion involving partial sternotomy but this needs to be confirmed in larger, adequately powered study
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