International Society For Minimally Invasive Cardiothoracic Surgery

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Single Centre's Experience With Minimally Invasive Aortic Valve Replacement Versus Conventional Full Sternotomy - Propensity Match Analysis
Sara Abou Sherif, Uday Trivedi, Amit Modi, Michael Lewis, Johnathan Hyde, David Quinn, Ishtiaq M Ahmed.
Royal Sussex County Hospital, Brighton, United Kingdom.

BACKGROUND - Minimally Invasive Aortic Valve Replacement (MIAVR) surgery is increasingly utilized as an acceptable alternative to conventional Full Sternotomy Aortic Valve Replacement (FSAVR), in an attempt to reduce surgical trauma and improve post-operative outcomes. The aim of this study was to compare the operative and post-operative outcomes of MIAVR to those after FSAVR.
METHODS - Between January 2014 and February 2018, 315 patients underwent isolated AVR; 81 of these were MIAVR (performed via an upper mini-sternotomy, carried into the right and left third intercostal space). Initially, univariate comparisons to evaluate overall operative and post-operative outcomes between the two groups, were carried out. Propensity score-match analysis of the same outcomes was then performed, in order to avoid selection biases and balance for confounding baseline patient characteristics.
RESULTS - Mean patient age was 69.711.5 years; 181 (58%) were males. In hospital mortality was 2% and 0% in the FSAVR and MIAVR groups, respectively. Cardiopulmonary bypass and aortic cross clamp times were 22 and 17 mins longer during MIAVR. Advantages of MIAVR, prior to matching, included reduced time to extubation, total hospital stay and incidence of permanent pacemaker implantation as well as decreased postoperative blood loss and amount of Fresh Frozen Plasma (FFP) transfused. Propensity score matching (1:1); based on 21 baseline characteristics, yielded 71 MIAVR/FSAVR patient pairs. After adjusting for the propensity score, post-operative blood loss at 12 and 24 hours as well as the amount of FFP transfused remained significantly reduced in the MIAVR group.
CONCLUSIONS- MIAVR is a safe alternative for FSAVR, however, from the volume of currently reported data, there remains to be clinical equipoise around the magnitude of the benefits of MIAVR. Objective benefits of MIAVR include a significant reduction of post-operative blood loss and FFP transfused, as well as a trend towards reduced ventilation time, incidence of pacemaker implantation and reduced hospital stay.

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