Temporal Trends And Structural Valve Degeneration In Minimally Invasive Surgical Aortic Valve Replacements At A Veterans Affairs Medical Center
Yuvraj Mahadeshwar1, Jay Patel2, Mohammad Arammash3, Norah E. Liang4, Liang Ge5, Elaine Tseng6, Marko Boskovski6.
1Geisel School of Medicine, Hanover, NH, USA, 2California University of Science and Medicine, Colton, CA, USA, 3University of California San Francisco School of Medicine, San Francisco, CA, USA, 4Massachusetts General Hospital, Boston, MA, USA, 5San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA, 6University of California San Francisco Division of Cardiothoracic Surgery, San Francisco, CA, USA.
BACKGROUND: Outcomes of minimally invasive surgical aortic valve replacements (MIAVRs) at lower volume federal facilities are not frequently reported. Additionally, there is now a focus on the size of implanted aortic valves due to the increased use of bioprosthetic valves in younger patients with later plans for valve-in-valve TAVR. The objective of our study was to elaborate on the evolution of MIAVR and temporal trends at a Veterans Affairs Medical Center (VAMC).METHODS: A single-center retrospective cohort study was performed of 144 consecutive patients, from January 2011 to December 2021, who underwent MIAVR for isolated aortic valvular disease. Our experience was divided into an early period (2011-2016) and late period (2017-2021). Preoperative STS risk factors were determined, and perioperative outcomes and temporal trends were analyzed.RESULTS: The early period consisted of 76 patients and the late period consisted of 68. There were no significant differences in demographics and pre-operative risk factors between the two groups. There were 6 conversions to full sternotomy in the early period and 1 in the late (7.9% vs. 1.5%, p = 0.12). The late period had significantly shorter cardiopulmonary bypass (120 vs. 75 minutes, p < 0.001) and cross-clamp times (81 and 54 minutes, p < 0.001). Significantly more larger valves were implanted over time (p < 0.001 for trend, LEGEND) with 85.3% of patients receiving a 25 or larger valve size in the late period, compared to 32.9% in the early period (p < 0.001). By Cox proportional hazard models, there were no differences in long-term mortality (p = 0.38). Additionally, no valves showed clinically significant postoperative insufficiency in both periods. Therefore, all valves were Stage 0 for structural degeneration, as defined by the Valve-in-Valve International Data (VIVID) group.CONCLUSIONS: Over time, there has been a significant decrease in operative times for MIAVR at our VAMC, with a concomitant increase in utilization of larger prostheses. 
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