Minimal Access Aortic Valve Replacement: Who Gains The Most?
Joseph George, Sobaran Sharma, Shi Sum Poon, Yasir Ahmed, Umair Aslam, Pankaj Kumar
Morriston Hospital, Swansea, United Kingdom
BACKGROUND: Minimally invasive cardiac surgery has the potential to reduce peri-operative morbidity not only through smaller incisions but also peri-operative complications and transfusion requirements. We investigated the impact of utilising a partial sternotomy (upper ‘J’-type) for isolated aortic valve replacement against conventional sternotomy in elderly patients and compared the outcomes including blood transfusion requirements.
METHODS: Operative records of patients aged 70 years and over, undergoing isolated aortic valve replacements were retrieved between 2014 and 2020. We compared patients demographics and peri-operative data between the two groups undergoing conventional sternotomy (group A) and partial sternotomy (group B). Categorical variables were compared using chi-squared test, continuous variables were compared using the Mann-Whitney test, following determination of the non-normal distribution of data.
RESULTS: 373 patients (Group A) and 97 patients (Group B) underwent isolated aortic valve replacement with conventional and partial sternotomy incisions respectively. There was an increased proportion of comorbidities in Group B as reflected in the significantly greater Euroscore (8.9% vs 10.4%, p<0.05). Cardiopulmonary bypass (99.5 vs 74.4 mins, p<0.0001) and cross-clamp times (81.5 vs 62.7 mins, p<0.0001) were shorter in Group B. There was no difference in in-hospital mortality (1.1% vs 0%, p=0.306). The intensive care utilisation more than 24 hours (49.7% vs 38.3%, p=0.050) was significantly lower in Group B, who interestingly also had a significantly shorter post-operative hospital stay (9.9 vs 8.1 days, p<0.0001). There was a significantly lower usage of packed red cell units in Group B (2.3 vs 1.5 units, p=0.009). CONCLUSIONS: We have demonstrated that minimal access approach aortic valve replacement can provide substantial clinical benefits, in particular the elderly and co-morbid patients, in addition to utilising fewer hospital resources such as post-operative care facilities, length of stay and blood products. 