International Society for Minimally Invasive Cardiothoracic Surgery

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Right Anterior Thoracotomy Versus Upper Hemisternotomy For Aortic Valve Replacement With Perceval S Valve: Is There Any Difference?
Bogdan Ranko Okiljevic, Tatjana Raickovic, igor Zivkovic, Petar Vukovic, Petar Milacic, Ivan Stojanovic, Slobodan Micovic.
Dedinje Cardiovascular Institute, Belgrade, Serbia.

Objective: The aim of our study was to evaluate the early outcomes of aortic valve replacement with Perceval S sutureless valve through the right anterior thoracotomy and upper hemisternotomy approaches, and to determine if there are any differences between these two approaches. Methods: We conducted a retrospective, single-center observational study using prospectively collected data from 174 patients who underwent minimally invasive Perceval S valve implantation for isolated aortic valve stenosis between January 2018 and August 2023. The patients were divided into two groups based on the approach used: the hemisternotomy group (n = 100) and rhe right anterior thoracotomy group (n = 74). Results: The overall in-hospital mortality was 1,7% (3 patients), with no significant differences between the two groups. The cardiopulmonary bypass and cross-clamp time were significantly longer in the right anterior thoracotomy group (p < .001). There were no statistically significant difference in terms of stroke, paravalvular leak, mechanical ventilation time, blood transfusion requirements, pacemaker implantation, reexploration for bleedeng, conversion to other surgical approach, wound infection, or in-hospital stay. Postoperative chest drainage was lower (p < .001) and postoperative atrial fibrilation occured less frequently (p = .044) in right anterior thoracotomy group. The median intensive care unit stay was shorter in right anterior thoracotomy group (p = .018). Conclusion: Aortic valve replacement with the Perceval S sutureless valve through either an upper hemisternotomy or a right anterior thoracotomy is a safe and reproducible procedure associated with low perioperative complication rates. Right anterior thoracotomy for aortic valve replacement with the Perceval S valve was associated with lower postoperative bleeding, a lower postoperative atrial fibrilation incidence and a shorter intensive care unit stay compared to upper hemistornotomy.Legend:TABLE 1. Intraoperative characteristics and postoperative outcomesData presented as mean standard deviation, n (%) or median (interquartule range). CPB, cardiopulmonary bypass; ICU, Intensive Care Unit.

Intraoperative characteristics and postoperative outcomes
Hemisternotomy AVRRight anterior thoracotomy AVRp
Cardiopulmonary bypass time74.9 17.692.2 37.6< .001
cross clamp time46.6 13.555.1 14.4< .001
paravalvular leak (more than mild)1 (1%)2 (2.7%).576
mortality2 (2%)1 (1.4%)1.000
stroke1 (1%)2 (2.7%).576
Reintervention for bleeding5 (5%)3 (4.1%)1.000
postoperativeatrial fibrillation31 (31%)13 (17.6%).044
ICU stay (days)2 (2)1.5 (2).018
In Hospital stay (days)7 (3)7 (4).802

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