Impact Of Minimally Invasive Aortic Valve Replacement On Myocardial Edema And Integrity
Serdar Gunaydin1, Kevin McCusker2.
1City Hospital, Ankara, Turkey, 2New York Medical College, New York, NY, USA.
Background: Endothelial glycocalyx (EG) and aquaporines (AQP) are biomarkers of myocardial integrity and the transportation of fluid out of the expanded interstitial space into the capillary. The present study aimed to compare plasma levels of syndecan-1, a biomarker of EG integrity and AQP levels in patients undergoing minimally invasive aortic valve surgery compared to conventional techniques. Methods: This prospective cohort study included patients undergoing aortic valve surgery between January 2017 and May 2019. Patients were matched for age, gender, BMI and STS score: Group 1(MiAVR): Minimally Invasive Technique (N=102) and Group 2 (control) N=109. The approach was hemi-median sternotomy and single dose cardioplegia (HTK) in Group 1 and full sternotomy with intermittent crystalloid cardioplegia (St. Thomas) in control. The expression of AQP was analyzed using quantitative real-time PCR and EG via syndecan-1 by ELISAwith a solid-phase monoclonal BB4 antibody against an extracellular domain of human Syndecan-1(coronary sinus samples before and after CPB). Results:There was one cerebrovascular accident in Group 2 and no aortic dissection in any group. Two femoral arterial pseudoaneurysms in Group 1 and three in Group 2 as well as 2 groin wound seromas in Group 2 were reported. The postoperative mean aortic valve gradient was 8.8 ± 3 mmHg in Group 1 and 11.1 ± 5 mmHg in control group.Serum Syndecan-1 and AQP levels were summarized in Fig. MiAVR protected microvascular integrity with significantly lower levels. AQP response to handling fluid transport was well conducted by secretion of significantly more AQP molecules in MiAVR. Perioperative data is summarized in Table. Conclusion:Given its importance, protection of the EG and satisfactory AQP response are undoubtedly promising future targets in cardiac operations. Significantly better clinical outcome was demonstrated in MiAVR group via less transfusion, respiratory support and less ICU-hospital stay which might be a result of positive impact on molecular level protection. 
| Group 1(miAVR)(N=102) | Group 2(Control)(N=109) | p | |
| Duration of x-clamp (min) | 63±15 | 59±12 | =0.08 |
| Respiratory Support (h) | 6.5±3* | 13.4±5 | =0.032 |
| Postop hemorrhage (mL) | 250±50* | 550±50 | =0.024 |
| Patients with no transfusion (%) | 64.7* | 32.1 | =0.011 |
| Blood product transfusion (Unit) | 1±0.5 | 2.8±0.5 | =0.046 |
| Incidence of Atrial Fib (%) | 28.4 | 32.01 | =0.14 |
| ICU stay (day) | 1.5±0.5* | 3.1±0.5 | =0.04 |
| Hospital stay (day) | 6.1±3* | 8.1±3 | =0.042 |
| Mortality (%) | 1 | 3 | >0.05 |
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