Evolution of Surgical Aortic Valve Replacement;Single Center Experience Over Three Years
Ayman Kenawy, David Rose, Joseph Zacharias.
Blackpool Victoria Hospital, Blackpool, United Kingdom.
Background Aortic valve disease is a common condition in the elderly and its prevalence increases with age.Surgical Aortic valve replacement (AVR) represents a considerable percentage of the current practice and it is routinely performed through a median sternotomy which poses a significant surgical burden particularly in the aging population.Minimal access surgical AVR, both hemi-sternotomy (HS) and Anterior Right Thoracotomy (ART) have not demonstrated any difference in mortality,morbidity or hospital stay compared with median sternotomy in recent propensity matched analysis.The rationale beyond this study is to show our initial experience in the minimal access approach despite the learning curve.Methods 394 patients received isolated first time AVR from May 2015 to April 2018 ,during that time period all 3 approaches were performed.264 procedure were performed through a median sternotomy, 72 were performed through HS and 58 through ART.Retrospective review of prospectively collected data was done and One way-ANOVA or Kruskal-Wallis were used to compare between groups with quantitative variables and Chi-square test or Fisher's exact were used to compare categorical variables.Results No difference in terms of early mortality, stroke and re-exploration for bleeding.The conversions were 2 in the ART group and 3 in the HS group.The cumulative bypass and cross clamp time were significantly longer in the minimally invasive group reflecting the learning curve.The post operative stay in ICU and the overall hospital stay was no different in the three group.Conclusion Minimal access AVR is associated with lower blood loss and shorter ICU stay however did not reach significance in our study.Despite the longer bypass and cross clamp time, both HS and ART could be performed safely with low mortality and post operative morbidity.The retrograde perfusion for the ART group is not associated with increased risk of stroke if compared with antegrade perfusion.It is safe to start minimal access AVR program with no compromise to patient safety.
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