Five-year Clinical Outcomes Of Isolated Aortic Valve Replacement Via Right Anterior Mini-thoracotomy
Ali Fatehi Hassanabad, Andrew Maitland, Daniel Holloway, Corey Adams, William DT Kent.
University of Calgary, Calgary, AB, Canada.
BACKGROUND: Contemporary surgical approaches for aortic valve replacement (AVR) include full median sternotomy, hemi-sternotomy, and right anterior mini thoracotomy (RAMT). Many studies have confirmed the safety and feasibility of RAMT AVR, and several centres have demonstrated excellent operative results, with low risk of mortality and perioperative stroke, comparable to conventional full sternotomy AVR. However, there is a paucity of data on longer term follow-up after RAMT AVR. Herein, we report the five-year clinical outcomes of RAMT for isolated AVR.
METHODS: This retrospective study investigated the 5-year clinical outcomes of patients who underwent isolated RAMT AVR in Calgary, Canada. Primary outcomes were death and disabling stroke within 30 days of surgery. Secondary outcomes were survival at 5-years follow-up, hospital readmission for aortic valve disease, prosthetic valve function (transvalvular mean pressure gradient and paravalvular leak), and incidence of structural valve deterioration requiring reintervention on the aortic valve.
RESULTS: Forty-five patients underwent isolated RAMT AVR between February 2016 and December 2017. The RAMT AVR was the first cardiac surgical intervention for all patients. Twenty-two were male and the average age at the time of surgery was 74.82±10.48 years. One patient died from a cardiac cause within 30 days of surgery, while none experienced disabling post-operative strokes post-operatively. At 5-years follow-up, 11 patients had died, including 2 from myocardial infarction and 1 from multi-system organ failure secondary to congestive heart failure. The other 8 mortalities were from non-cardiac causes. No patient required re-hospitalization within 30 days for a post-op complication, and no one required reintervention on their prosthetic aortic valve. During the follow-up period, two patients underwent median sternotomy, 1 for mitral valve replacement and tricuspid repair, and 1 for coronary artery bypass grafting. At last follow-up there was no echocardiographic evidence of structural valve deterioration; the mean transvalvular gradient was 11.85±7.17 mmHg; and there was no incidence of greater than mild paravalvular leak.
CONCLUSIONS: RAMT AVR can be safely done in the appropriate patient population. The 5-year follow-up outcomes of isolated RAMT AVR at our center are promising and suggest this approach is a good option for managing aortic stenosis. Future studies should be conducted to compare the long-term outcomes of RAMT AVR to conventional approaches and TAVR.
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