Minimally Invasive Aortic Valve Replacement In Combination With A Sutureless Valve And Fast-track Regime: A Safe Combination Even In Elderly
Marie Lamberigts1, Filip Rega2, Peter Verbrugghe2, Christophe Dubois2, Bart Meuris2.
1KU Leuven, Leuven, Belgium, 2UZ Leuven, Leuven, Belgium.
BACKGROUND: Fast-track regimes and minimal invasive surgery have common goals, aiming to reduce ICU and hospital length of stay, minimize resource usage and improving patient recovery. The objective of this study was to analyze the combination of 3 elements: fast-track regime, use of a sutureless aortic valve and minimal access surgery.
METHODS: This is a retrospective, monocentric study of all patients treated with a single aortic valve replacement using a sutureless valve between January 2007 and June 2022. All patients had to be treated via a minimally invasive technique and were fast-tracked after surgery. Our center aims to use a fast-track regime for all patients scheduled for single valve procedures with a low EuroSCORE II (<4%).
RESULTS: We treated 150 patients with a median age of 79 years (interquartile range (IQR) 74-83y). In total, 106 patients (70.7%) were older then 75y (Figure 1). Minimally invasive techniques included mainly ministernotomy (95.3%) and 7 cases of minithoracotomy (4.7%). Median cardiopulmonary bypass time was 57 minutes (IQR: 48-66 minutes) and median cross-clamp time was 36 minutes (29-43 minutes). All patients stayed overnight in the recovery unit, the total median hospitalization period 7 days (IQR: 6 - 9 days). In-hospital mortality and 30-day mortality were both 0%. Postoperative complications were2 cases of stroke (1.3%), 0 cases of new need for dialysis and 10 permanent pacemaker implantations (6.7%). At discharge, median peak gradient was 21.5 mmHg (IQR: 18-28 mmHg), mean gradient was 12 (IQR: 10-16 mmHg) and 2 patients (1.3%) had a paravalvular leak >1/4. CONCLUSIONS: In a cohort with a majority of patients aged above 75 years old, we saw no early mortality and a low stroke rate, in combination with good hemodynamics, low pacemaker rates and low rate of paravalvular leakage. The shortness and simplicity of sutureless AVR facilitates minimally invasive AVR and allows for application of a fast track recovery regime. Good results can be obtained, even in elderly patients above 75y, where current guidelines direct patients more towards TAVI.
"LEGEND: Figure 1. Histogram of age at operation, red vertical line at 75 years".
Back to 2023 ePosters