Midterm Outcomes Of Aortic Valve Surgery Through A Right Anterior Small Thoracotomy (rast)
Laina Passos, Thierry Aymard, Roberto Corti, Patric Biaggi, Jürg Grünenfelder, Diana Reser.
Herzklinik Hirslanden, zurich, Switzerland.
BACKGROUND: Aortic valve surgery through a right anterior small thoracotomy (RAST) evolved to an accepted procedure in specialized centres worldwide. Ten years ago, we have established a structural heart-team centre where we discuss every valve case in order to offer patient tailored therapies (surgery versus interventional). The aim of our study was to analyse the outcomes of our single-centre heart-team-decision-based RAST cohort with regard to morbidity, mortality and midterm outcomes. METHODS: Preoperative characteristics, in-hospital outcomes and follow-up information about survival and need for reoperation were collected by contacting the patients and the referring cardiologists. RESULTS:We identified a total of 316 consecutive patients operated through RAST without rib-exarticulation. During the same time, 1330 patients received a TAVR and 29 a full sternotomy. Mean age was 62.5±6.1 years, 16% were older than 75 years, 29% were women, Euroscore II was 1±0.05. Cross-clamp time was 72±24 minutes, three patients were converted to sternotomy (0.9%). Thirty-day mortality was 0.3% and there were two strokes (0.62%). Mean follow up time was 2.5 years with up to 9 years. At 1 and 5 years, survival was 99.3% and 98.7% respectively. Three patients died during follow up of unreported causes. They were all older than 75 years. One patient (0.3%) needed a re-operation due to endocarditis six months after the first surgery. CONCLUSIONS:In our specialized structural heart-team centre with patient tailored decision-making, we are able to offer RAST with an in-hospital mortality below 1%, low morbidity, need for reoperation and favourable mid-term survival. RAST might soon become the only acceptable surgical treatment option in the era of interventional procedures and these excellent results should serve as benchmark for the implementation of new interventions, especially in younger and low-risk patient populations.
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