Propensity Score Matched Analysis Of Conventional Versus Minimally Invasive Aortic Arch Replacement
Eduard Charchyan, Denis Breshenkov, Yuriy Belov.
Petrovskiy Russian Research Center of Surgery, Moscow, Russian Federation.
Background: Systematic reviews of minimally invasive aortic valve surgery showed certain advantages over conventional surgery. New trends were introduced in aortic arch surgery. Aim of our study to compare the results conventional aortic arch replacement with minimally invasive technique (MIT) Methods: A total of 258 patients undergoing aortic arch surgery from 2009 to 2018 at our center. Minimally invasive surgical approach included J-ministernotomy and peripheral cannulation (right subclavian artery and femoral vein) and was performed of 21 (8.2%) patients of them 10(47,6%) patients - frozen elephant trunk procedure, 2(9,5%) - elephant trunk procedure and 9(42,9%) - hemiarch procedure(Fig 1.) Propensity score matching produced 21 (ministernotomy vs. full sternotomy (FS)) well-matched pairs to correct for differences in baseline characteristics. Primary endpoints were in-hospital mortality, blood loss, complications, intensive care unit stay, hospital stay, 30-day survival; secondary endpoints were 1-years follow up survival, stroke, reinterventions and reoperations. A P value of less than 0.05 was considered significant. Results: Of all 155 included patients, 42 remained after propensity score matching matching (table 1). After matching not differ between groups to cross-clamp time (116±41 (MIT) vs. 109±15 (FS) , p= .467), circulatory arrest (53±7 (MIT) vs. 48,5±8 (FS), p= .059), antegrade bilateral cerebral perfusion (48±13 (MIT) vs. 42,7±9 (FS), p= .132). Blood loss (862±96 ml vs. 1373,81±96 ml, P = 0.001), postoperative drainage loss (388±96 vs. 590±96 ml, P = 0.001), ventilation time (7,8±1,9 vs. 12,7±1,5 hours, P = 0.001), ICU stay (1,2±0,4 vs. 5,6±0,6 days, P = 0.001) and hospital stay (8±1,2 vs. 14±1,7 days , P = 0.001) were lower after MIT. Rate of pulmonary complications was lower in MIT group (2 (9,6%) vs. 6(28%), P = 0.05). One patient died from septic shock at 43 days after operation in MIT group. In-hospital mortality was 4,8% in both groups. 1-years follow up no differ in both groups 95% (MIT) vs. 95% (FS). Conclusion: Minimally invasive technique is associated with a lower blood loss, postoperative drainage loss, ventilation time, pulmonary complications and shorter length of stay compared with conventional surgery. Partial sternotomy was not associated with a significantly increased mortality and postoperative complications. However, retrospective design and limitations of low number patients requires prospective, randomized trials to further define the safety and efficacy minimally invasive approach.
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