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Early Outcomes Of Isolated Aortic Valve Replacement Through Right Anterior Mini Thoracotomy Using The Latest Generation Biological Prosthesis
Hossein Amirjamshidi1, Ariana Goodman2, Peter A. Knight1.
1University of Rochester Medical Center, Rochester, NY, USA, 2University of Rochester, Rochester, NY, USA.
Background: The latest generation of St. Jude Medical Inc (St Paul, Minn) Trifecta valve incorporates several design features including a proprietary anticalcification technology, which is said to give the valve improved hemodynamics. The objective of this study is to evaluate early and intermediate outcomes and hemodynamics of the latest generation Trifecta valve implanted using right anterior mini-thoracotomy. Methods: We performed a single center, retrospective, observational study including 175 individuals who underwent isolated minimally invasive aortic valve replacement (mini-AVR) with the latest generation Trifecta valves through a right anterior mini-thoracotomy between January 2016 and January 2019. Exclusion criteria included conversion to median sternotomy 2.8% (n=5), and concomitant procedures. The mean age of the population was 64 ± 13 years, 58.2% (n=103) male and 41.8% (n=74) female. Indications for aortic valve replacement included stenosis, regurgitation and mixed pathology. Analyses addressed implantation safety, 30 day and intermediate-term survival and hemodynamic performance of the valves. Results: Overall, patients were followed with duration ranging from 0.5 to 3 years. Early (less than 30 days) mortality occurred in 2 patients (1.1%), and there were 8 (4.5%) late (greater than 31 days) deaths. Early thromboembolic events and postoperative bleeding requiring reoperation occurred at a rate of 3.9% (n=7), and 8.5% (n=15) respectively. Overall, Mean gradient across all valve sizes were 6.56 ± 3.03 mm Hg post valve replacement and remained low at 6.79 ± 2.93 mm Hg with mean effective orifice area of 1.81±0.43 cm2 at the last follow-up visit. There was one case of infective prosthetic endocarditis, which did not require valve explant. There were no reoperations due to valve related problems during the study period. Conclusions: This is the largest series reporting on outcomes of the latest generation Trifecta valve implanted using right anterior mini-thoracotomy. Our results demonstrate that this valve can be safely implanted via a minimally invasive approach with excellent early and intermediate outcomes and hemodynamic performance.
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