Minimally Invasive Aortic Valve Replacement Decreases Stroke Risk In Long-term Observation
Marcin Kaczmarczyk1, Tomasz Hrapkowicz1, Krzysztof Filipiak2, Krzysztof Kubacki1, Michał Zembala1.
1Silesian Center for Heart Diseases, Zabrze, Poland, 2Cardiac Surgery Department Pomeranian Medical University, Szczecin, Poland.
BACKGROUND: It has been suggested that minimally invasive aortic valve replacement (MIAVR) could reduce the incidence of early postoperative neurological complications, nevertheless its impact on long-term results has not yet been fully assessed. The aim of this study was to evaluate long-term cerebrovascular risk after sAVR depending on the surgical technique used (minimally invasive vs. standard) and to determine in parallel, which patient- and treatment-related attributes contributed most to faster stroke development after surgery.METHODS: Out of 2147 patients who underwent sAVR at our institution from 01.2006 to 12.2017, 1696 individuals have been ultimately evaluated (79%). Two surgical approaches have been performed, among which 28% were minimally invasive through J-shaped ministernotomy (MIAVR) and 72% conventional through full sternotomy (FSAVR). For the purposes of the study, three types of predictors have been specified. The first was determined by patient dependent factors, while the second consisted of intraoperative measures and early in-hospital outcomes. The mini-invasive indicator represented the third predictor type. An event was defined by hospitalization for ischemic or hemorrhagic stroke. Multivariate Cox regression has been applied to build an independent Cox predictive late cerebrovascular event model.RESULTS: Our Cox predictive model revealed that MIAVR was a meaning, protective factor against stroke occurrence [HR=0,52; p=0,03] and such benefit was noticeable throughout the entire follow-up observation. The hazard for the subjects being treated minimally invasively has been reduced by 48% compared with FSAVR. Previous stroke history [HR=2,09; p=0,02], the presence of atrial fibrillation [HR=1,58; p=0,04], the coexistence of diabetes [HR=1,44; p=0,07] and postoperative psychosis [HR=2,0; p=0,01] were predictive agents of late cerebrovascular event(Tab.1).CONCLUSIONS: MIAVR decreases stroke risk for sAVR population during 11-year follow-up. MIAVR procedure should be especially recommended for the individuals with previous stroke history, additionally suffering from preoperative atrial fibrillation and diabetes to minimize its negative impact on long-term cerebrovascular risk. 
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