1
|
Mikus E, Fiorentino M, Sangiorgi D, Calvi S, Tenti E, Tripodi A, Savini C. Optimizing Aortic Valve Reoperations: Ministernotomy vs. Full Sternotomy. J Clin Med 2025; 14:1213. [PMID: 40004743 PMCID: PMC11856763 DOI: 10.3390/jcm14041213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 02/05/2025] [Accepted: 02/11/2025] [Indexed: 02/27/2025] Open
Abstract
Background: The minimally invasive approach, performed via ministernotomy, is now often preferred for isolated aortic valve replacement (AVR). However, its benefits in patients with prior cardiac surgery remain unclear. This article compares traditional and minimally invasive surgery for isolated aortic valve replacement in reoperative cases. Methods: A retrospective analysis of 382 patients who underwent reoperative AVR between January 2010 and June 2024 divided them into two groups: 309 patients (80.1%) had a traditional full sternotomy, while 73 patients (19.1%) had minimally invasive AVR via upper ministernotomy. Results: Significant differences were noted between the groups. The full sternotomy group had a higher logistic EuroSCORE (SMD = 0.203), more patients with active endocarditis (SMD = 0.312), and a higher pacemaker rate. To minimize bias, inverse probability of treatment weighting (IPTW) was used. The minimally invasive group had shorter aortic cross-clamp (50 vs. 65 min, p < 0.001) and cardiopulmonary bypass times (62 vs. 85 min, p < 0.001), shorter intensive care unit (ICU) stays (p < 0.001), lower rates of acute renal failure (p = 0.001), and less blood loss (p < 0.001), but similar transfusion needs. Early mortality was higher in the full sternotomy group (4.5% vs. 1.6%, p = 0.025). Conclusions: Minimally invasive aortic valve reoperation via upper "J" sternotomy is as safe as full sternotomy. Patients experienced lower rates of acute renal failure and less postoperative bleeding, contributing to a safer recovery with decreased hospital mortality.
Collapse
Affiliation(s)
- Elisa Mikus
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy; (M.F.); (D.S.); (S.C.); (E.T.); (A.T.); (C.S.)
| | - Mariafrancesca Fiorentino
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy; (M.F.); (D.S.); (S.C.); (E.T.); (A.T.); (C.S.)
| | - Diego Sangiorgi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy; (M.F.); (D.S.); (S.C.); (E.T.); (A.T.); (C.S.)
| | - Simone Calvi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy; (M.F.); (D.S.); (S.C.); (E.T.); (A.T.); (C.S.)
| | - Elena Tenti
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy; (M.F.); (D.S.); (S.C.); (E.T.); (A.T.); (C.S.)
| | - Alberto Tripodi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy; (M.F.); (D.S.); (S.C.); (E.T.); (A.T.); (C.S.)
| | - Carlo Savini
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy; (M.F.); (D.S.); (S.C.); (E.T.); (A.T.); (C.S.)
- Department of Experimental Diagnostic and Surgical Medicine (DIMEC), University of Bologna, 40126 Bologna, Italy
| |
Collapse
|
2
|
Furutachi A, Nakamura Y, Niitsuma K, Ushijima M, Yasumoto Y, Yoshiyama D, Kuroda M, Nakamae K, Hayashi Y, Nakayama T, Tsuruta R, Ito Y. Midterm Outcomes of Minimally Invasive Aortic Valve Replacement via Right Lateral Minithoracotomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2025:15569845241308005. [PMID: 39895018 DOI: 10.1177/15569845241308005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2025]
Abstract
OBJECTIVE Minimally invasive aortic valve replacement (MIAVR) procedures have been found to have good short-term results. However, no known reports regarding outcomes of MIAVR via a right lateral minithoracotomy (LT) approach over longer terms have been presented. The aim of the present study was to analyze the midterm outcomes of the use of MIAVR with the right LT approach over an 8-year period. METHODS Between September 2014 and February 2023, MIAVR was performed for 348 patients with severe aortic valve stenosis and regurgitation at our hospital. Operative mortality, all-cause mortality, and valve-related events were retrospectively examined. RESULTS The mean patient age was 72.3 ± 10.9 years, while 78 patients (22.4%) were more than 80 years old. Surgical, cardiopulmonary bypass, and cross-clamp times were 194.7 ± 43.2, 118.6 ± 28.7, and 89.4 ± 23.3 min, respectively. The 30-day mortality rate was 0.3%. The mean follow-up period was 35.6 ± 25.9 months. Overall survival shown by Kaplan-Meier analysis at 1, 3, and 5 years was 96.4%, 90.3%, and 83.2%, respectively, and freedom from valve-related events at those time points was noted in 100%, 99.5%, and 96.9% of the cases, respectively. CONCLUSIONS MIAVR via a right LT approach was found to be associated with excellent short-term and midterm outcomes and is considered to have the potential to become an established surgical option.
Collapse
Affiliation(s)
- Akira Furutachi
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Japan
| | | | - Kusumi Niitsuma
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Japan
| | - Masaki Ushijima
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Japan
| | - Yuto Yasumoto
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Japan
| | - Daiki Yoshiyama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Japan
| | - Miho Kuroda
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Japan
| | - Kosuke Nakamae
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Japan
| | - Yujiro Hayashi
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Japan
| | - Taisuke Nakayama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Japan
| | - Ryo Tsuruta
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Japan
| | - Yujiro Ito
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Japan
| |
Collapse
|
3
|
Salamate S, Bakhtiary F, Bayram A, Silaschi M, Akhavuz Ö, Doss M, Sirat S, Ahmad AES. Endoscopic Minimally Invasive Approach Versus Median Sternotomy for Multiple-Valve Surgery: A Propensity-Matched Analysis. Adv Ther 2025; 42:261-279. [PMID: 39520659 PMCID: PMC11782361 DOI: 10.1007/s12325-024-03008-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 09/23/2024] [Indexed: 11/16/2024]
Abstract
INTRODUCTION Endoscopic minimally invasive valve surgery is a promising alternative to valve surgery through median sternotomy. Our study compared the short-term outcomes of patients undergoing endoscopic minimally invasive multiple concomitant valve surgeries (MIMVS) with median sternotomy (MS). METHODS Demographic, clinical, and procedural data of all consecutive patients who underwent multiple-valve surgeries at two institutions in Germany from March of 2017 to March of 2023 were retrospectively collected. Patients were divided into two groups: MIMVS versus MS and their outcomes were compared before and after propensity score matching. Primary endpoint was the incidence of 30-day mortality. RESULTS A total of 317 patients were included in the study; 112 patients in each group were matched 1:1. MIMVS was performed on 123 patients. After propensity matching, 30-day mortality rates were 8% for MIMVS versus 12.5% for MS (p = 0.28). Median blood transfusion in the MIMVS group was 0 [0-3] vs 1 [0-4] in the MS group (p = 0.002). MIMVS was associated with similar cardiopulmonary bypass time 105.5 [79.8-124] versus 98 [68.8-130.3] mins and aortic cross clamping times 70 [53-80.3] versus 63.5 [46-90.3] mins (p values 0.9 and 0.76, respectively). Median intensive care and inhospital stays were similar between both groups (2 [1-4] vs 2 [1-5] days, p = 0.36, and 12 [8-17] vs 12.5 [9-21] days, p = 0.38). Incidences of intrathoracic bleeding, stroke, and acute kidney injury were similar in both groups. CONCLUSIONS In our experience, endoscopic minimally invasive multiple-valve surgeries through right anterior mini-thoracotomy is as feasible, safe, and effective as medial sternotomy in select patients.
Collapse
Affiliation(s)
- Saad Salamate
- Department of Cardiac Surgery, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Ali Bayram
- Division of Cardiac Surgery, Heart Centre Siegburg, Siegburg, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Ömür Akhavuz
- Department of Cardiac Surgery, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Mirko Doss
- Division of Cardiac Surgery, Heart Centre Siegburg, Siegburg, Germany
| | - Sami Sirat
- Division of Cardiac Surgery, Heart Centre Siegburg, Siegburg, Germany
| | - Ali El-Sayed Ahmad
- Department of Cardiac Surgery, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| |
Collapse
|
4
|
Lella SK, Ferrell BE, Sugiura T. Contemporary Management of the Aortic Valve-Narrative Review of an Evolving Landscape. J Clin Med 2024; 14:134. [PMID: 39797217 PMCID: PMC11722002 DOI: 10.3390/jcm14010134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 12/25/2024] [Accepted: 12/27/2024] [Indexed: 01/13/2025] Open
Abstract
Background: Aortic valve replacement has undergone novel changes in recent decades, providing not only a multitude of procedural options but expanding the treatable patient population. Specifically, a number of minimally invasive and interventional treatment options have allowed for the treatment of high and prohibitive risk surgical patients. Further, technology is allowing for the development of innovative surgical and transcatheter valve models, which will advance the treatment of aortic valve disease in the future. Objective: Here, we choose to describe the modern aortic valve replacement techniques and the available valves and designs.
Collapse
Affiliation(s)
- Srihari K. Lella
- Division of Cardiothoracic Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY 10467, USA; (S.K.L.); (B.E.F.)
| | - Brandon E. Ferrell
- Division of Cardiothoracic Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY 10467, USA; (S.K.L.); (B.E.F.)
| | - Tadahisa Sugiura
- Division of Cardiothoracic Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY 10467, USA; (S.K.L.); (B.E.F.)
- Montefiore Medical Center, Department of Cardiothoracic and Vascular Surgery, Medical Arts Pavilion, 3400 Bainbridge Road, 5th Floor, Bronx, NY 10467, USA
| |
Collapse
|
5
|
Danial P, Frering A, Bouhdadi H, Juvin C, Laali M, Barreda E, D'Alessandro C, Mansour N, Lansac E, Djavidi N, Bouglé A, Lebreton G, Leprince P. Lower Ministernotomy: An Approach for Treating All Valvulopathies? Ann Thorac Surg 2024:S0003-4975(24)01113-5. [PMID: 39732414 DOI: 10.1016/j.athoracsur.2024.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 12/04/2024] [Accepted: 12/09/2024] [Indexed: 12/30/2024]
Abstract
BACKGROUND Lower ministernotomy offers the advantage of providing excellent visualization of the 4 cardiac cavities, thus allowing surgical treatment of the aortic, mitral, and tricuspid valves as well as any intracavitary procedure. Information on technical issues, as well as safety and echocardiographic results of this approach, are sparse. The aim of this retrospective study was to describe outcomes of lower ministernotomy to treat valvulopathies and for other intracardiac surgical procedures. METHODS All consecutive patients aged more than 18 years who underwent cardiac surgery by ministernotomy between January 2017 and March 2023 in our institution (Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France) were included in this retrospective study. Main outcome variables were all-cause mortality, postoperative complications, and echocardiographic results. RESULTS During the 6-year study period, 633 patients were treated through a lower ministernotomy. Among them, 338 patients had aortic valve surgery (AVS) with or without tricuspid annuloplasty (TA), 254 had mitral valve surgery (MVS) with or without TA, 25 had AVS and MVS with or without TA, and 38 had other types of intracardiac surgery. Hospital survival was 99.1% in the AVS group, 98.1% in the MVS with or without TA group, 96% in the AVS and MVS with or without TA group, and 97.4% in the other intracardiac surgery group. Only 1 patient required repeat osteosynthesis in the entire cohort, and 12 (2.1%) patients had mediastinitis. A total of 162 (25%) patients received transfusions, 11 patients (1.7%) had permanent strokes, and 49 (7.5%) underwent new pacemaker implantation. CONCLUSIONS Lower ministernotomy is a safe approach for treating all valvulopathies, separately or concomitantly, and other intracardiac diseases, and it is associated with a low rate of morbidity and mortality.
Collapse
Affiliation(s)
- Pichoy Danial
- Department of Cardiovascular and Thoracic Surgery, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France; French Clinical Research Infrastructure Network (F-CRIN) Cardiovascular and Renal Clinical Trialists (INI-CRCT), Nancy, France.
| | - Anouk Frering
- Department of Cardiovascular and Thoracic Surgery, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France
| | - Hanae Bouhdadi
- Department of Cardiovascular and Thoracic Surgery, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France
| | - Charles Juvin
- Department of Cardiovascular and Thoracic Surgery, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France
| | - Mojgan Laali
- Department of Cardiovascular and Thoracic Surgery, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France
| | - Eleodoro Barreda
- Department of Cardiovascular and Thoracic Surgery, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France
| | - Cosimo D'Alessandro
- Department of Cardiovascular and Thoracic Surgery, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France
| | - Nadia Mansour
- Department of Cardiovascular and Thoracic Surgery, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France
| | - Emmanuel Lansac
- Department of Cardiovascular and Thoracic Surgery, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France
| | - Nima Djavidi
- Clinical Research Group (GRC) 29, Sorbonne University, Public Assistance Hospitals of Paris (AP-HP), Diagnostics, Radiology, Functional Investigations, Anatomopathology, Nuclear Medicine Medical University Departments, Department of Anesthesia and Resuscitation-, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Adrien Bouglé
- Clinical Research Group (GRC) 29, Sorbonne University, Public Assistance Hospitals of Paris (AP-HP), Diagnostics, Radiology, Functional Investigations, Anatomopathology, Nuclear Medicine Medical University Departments, Department of Anesthesia and Resuscitation-, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Guillaume Lebreton
- Department of Cardiovascular and Thoracic Surgery, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France
| | - Pascal Leprince
- Department of Cardiovascular and Thoracic Surgery, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France
| |
Collapse
|
6
|
Kim SS, Pospishil L, Neuburger PJ. Sutureless Valves: The Goldilocks Solution for Aortic Valve Disease? J Cardiothorac Vasc Anesth 2024; 38:2869-2872. [PMID: 39428284 DOI: 10.1053/j.jvca.2024.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 10/02/2024] [Indexed: 10/22/2024]
Affiliation(s)
- Sunny S Kim
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Liliya Pospishil
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY.
| |
Collapse
|
7
|
De Vos M, Meyns B, Quarck RA, Belge C, Godinas L, Rex S, Vlasselaers D, Delcroix M, Verbelen T. Pulmonary endarterectomy through inverted-T upper hemisternotomy. JTCVS Tech 2024; 28:65-72. [PMID: 39669357 PMCID: PMC11632390 DOI: 10.1016/j.xjtc.2024.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 08/31/2024] [Accepted: 09/23/2024] [Indexed: 12/14/2024] Open
Abstract
Objective We aimed to explore the feasibility of an inverted-T upper hemisternotomy approach for pulmonary endarterectomy (PEA) and report the results after 17 cases. Methods PEA was conducted through a 7-cm skin incision using an inverted-T upper hemisternotomy across the third intercostal spaces. Cardiopulmonary bypass (CPB) was established through central arterial and percutaneous femoral dual-staged venous cannulation. Perioperative and hemodynamic data were compared with 17 previous conventional PEAs performed by the same surgeon. Results From July 2022 to September 2023, 22 PEAs were performed, 17 through inverted-T upper hemisternotomy. Contraindications were an inferior caval vein filter, concomitant coronary revascularization or mitral valve surgery, pulmonary artery intimal sarcoma, and an emergency. Compared with 17 preceding conventional PEAs, there was no significant difference in demographics or in CPB time (274 [256-301] vs 264 [250-274] minutes, P = .1629), deep hypothermic circulatory arrest time (56 [45-65] vs 54 [50-58] minutes, P = .9587), preoperative pulmonary vascular resistance (4.12 [3.10-4.79] vs 4.49 [3.25-6.24] Wood units, P = .5890), 6-month postoperative pulmonary vascular resistance (1.90 [1.40-2.56] vs 1.83 [1.44-2.20] Wood units, P = .6374), or hospital stay (10 [8-12] vs 11 [9-14] days, P = .3327). Intravenous opioid use (0.29 [0.21-0.83] vs 2.99 [1.31-4.33] mg, P < 1.10-4) was significantly lower. Conclusions PEA using an inverted-T upper hemisternotomy approach is feasible and safe and obtains similar hemodynamic results compared with a full sternotomy approach without prolonging CPB and deep hypothermic circulatory arrest times. It offers bilateral treatment via a single incision and has few contraindications.
Collapse
Affiliation(s)
- Marie De Vos
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Rozenn Anne Quarck
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Catharina Belge
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Laurent Godinas
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Vlasselaers
- Department of Intensive Care, University Hospitals Leuven, Leuven, Belgium
| | - Marion Delcroix
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Tom Verbelen
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
8
|
Taghizadeh-Waghefi A, Petrov A, Arzt S, Alexiou K, Matschke K, Kappert U, Wilbring M. Minimally Invasive Aortic Valve Replacement for High-Risk Populations: Transaxillary Access Enhances Survival in Patients with Obesity. J Clin Med 2024; 13:6529. [PMID: 39518667 PMCID: PMC11546103 DOI: 10.3390/jcm13216529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 10/15/2024] [Accepted: 10/28/2024] [Indexed: 11/16/2024] Open
Abstract
Background/Objectives: Minimally invasive cardiac surgery is often avoided in patients with obesity due to exposure and surgical access concerns. Nonetheless, these patients have elevated periprocedural risks. Minimally invasive transaxillary aortic valve surgery offers a sternum-sparing "nearly no visible scar" alternative to the traditional full sternotomy. This study evaluated the clinical outcomes of patients with obesity compared to a propensity score-matched full sternotomy cohort. Methods: This retrospective cohort study included 1086 patients with obesity (body mass index [BMI] of >30 kg/m2) undergoing isolated aortic valve replacement from 2014 to 2023. Two hundred consecutive patients who received transaxillary minimally invasive cardiac lateral surgery (MICLAT-S) served as a treatment group, while a control group was generated via 1:1 propensity score matching from 886 patients who underwent full sternotomy. The final sample comprised 400 patients in both groups. Outcomes included major adverse cardio-cerebral events, mortality, and postoperative complications. Results: After matching, the clinical baselines were comparable. The mean BMI was 34.4 ± 4.0 kg/m2 (median: 33.9, range: 31.0-64.0). Despite the significantly longer skin-to-skin time (135.0 ± 37.7 vs. 119.0 ± 33.8 min; p ≤ 0.001), cardiopulmonary bypass time (69.1 ± 19.1 vs. 56.1 ± 21.4 min; p ≤ 0.001), and aortic cross-clamp time (44.0 ± 13.4 vs. 41.9 ± 13.3 min; p = 0.044), the MICLAT-S group showed a shorter hospital stay (9.71 ± 6.19 vs. 12.4 ± 7.13 days; p ≤ 0.001), lower transfusion requirements (0.54 ± 1.67 vs. 5.17 ± 9.38 units; p ≤ 0.001), reduced postoperative wound healing issues (5.0% vs. 12.0%; p = 0.012), and a lower 30-day mortality rate (1.5% vs. 6.0%; p = 0.031). Conclusions: MICLAT-S is safe and effective. Compared to traditional sternotomy in patients with obesity, MICLAT-S improves survival, reduces postoperative morbidity, and shortens hospital stays.
Collapse
Affiliation(s)
- Ali Taghizadeh-Waghefi
- Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Asen Petrov
- Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Sebastian Arzt
- Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Konstantin Alexiou
- Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Klaus Matschke
- Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Utz Kappert
- Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Manuel Wilbring
- Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| |
Collapse
|
9
|
Okiljevic B, Raickovic T, Zivkovic I, Vukovic P, Milicic M, Stojanovic I, Milacic P, Micovic S. Right anterior thoracotomy vs. upper hemisternotomy for aortic valve replacement with Perceval S: is there a difference? Front Cardiovasc Med 2024; 11:1369204. [PMID: 39526183 PMCID: PMC11543525 DOI: 10.3389/fcvm.2024.1369204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 10/17/2024] [Indexed: 11/16/2024] Open
Abstract
Background Our study aimed 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 carried out a study using data from 174 patients who underwent minimally invasive Perceval S valve implantation for aortic valve stenosis between January 2018 and August 2023. This was a retrospective, single-center observational study. The patients were divided into two groups: the hemisternotomy group (n = 100) and the right anterior thoracotomy group (n = 74). Results The overall in-hospital mortality was 1,7%. The cardiopulmonary bypass and cross-clamp times were longer in the right anterior thoracotomy group (p < .001). There were no statistically significant differences in terms of stroke, paravalvular leak, mechanical ventilation time, blood transfusion requirements, pacemaker implantation, reexploration for bleeding, conversion, wound infection, or in-hospital stay. Postoperative chest drainage was lower (p < .001) and postoperative atrial fibrillation occurred less frequently (p = .044) in the right anterior thoracotomy group. The median intensive care unit stay was shorter in the right anterior thoracotomy group (p = .018). Conclusion Aortic valve replacement with the Perceval S valve through either an upper hemisternotomy or a right anterior thoracotomy is a procedure associated with low perioperative complication rates. Right anterior thoracotomy for an aortic valve replacement with the Perceval S valve was associated with lower postoperative bleeding, a lower postoperative atrial fibrillation incidence and a shorter intensive care unit stay compared to upper hemistornotomy.
Collapse
Affiliation(s)
- Bogdan Okiljevic
- Cardiac Surgeon, Clinic for Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Tatjana Raickovic
- Cardiac Surgeon, Clinic for Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Igor Zivkovic
- Cardiac Surgeon, Clinic for Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Petar Vukovic
- Cardiac Surgeon, Clinic for Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miroslav Milicic
- Cardiac Surgeon, Clinic for Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Stojanovic
- Cardiac Surgeon, Clinic for Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Petar Milacic
- Cardiac Surgeon, Clinic for Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slobodan Micovic
- Cardiac Surgeon, Clinic for Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
10
|
Lee H, Kim J, Lee JH, Yoo JS. Minimally Invasive Approach versus Sternotomy for Cardiac Surgery in Jehovah's Witness Patients. J Cardiothorac Vasc Anesth 2024; 38:1907-1913. [PMID: 38955617 DOI: 10.1053/j.jvca.2024.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE To evaluate the outcomes of minimally invasive cardiac surgery (MICS) compared with the sternotomy approach for Jehovah's Witness (JW) patients who cannot receive blood transfusions DESIGN: This was a retrospective observational study. SETTING The study was conducted at a specialized cardiovascular intervention and surgery institute. PARTICIPANTS The study cohort comprised JW patients undergoing cardiac surgery between September 2016 and July 2022. INTERVENTIONS None MEASUREMENTS AND MAIN RESULTS: Patients (n = 63) were divided into MICS (n = 19) and sternotomy (n = 44) groups, and clinical outcomes were analyzed. There was no difference in types of operation except coronary bypass grafting (n = 1 [5.3%] in the MICS group v n = 20 [45.5%] in the sternotomy group; p = 0.005). There were no between-group differences in early mortality and morbidities. Overall survival did not differ significantly during the follow-up period (mean, 43.9 ± 24.4 months). The amount of chest tube drainage was significantly lower in the MICS group on the first postoperative day (mean, 224.0 ± 122.7 mL v 334.0 ± 187.0 mL in the sternotomy group; p = 0.022). The mean hemoglobin level was significantly higher in the MICS group on the day of operation (11.7 ± 1.3 mg/dL v 10.6 ± 2.0 mg/dL in the sternotomy group; p = 0.042) and the first postoperative day (12.3 ± 1.8 mg/dL v 11.2 ± 1.9 mg/dL; p = 0.032). CONCLUSIONS MICS for JW patients showed favorable early outcomes and mid-term survival compared to conventional sternotomy. MICS may be a viable option for JW patients who decline blood transfusions.
Collapse
Affiliation(s)
- Heemoon Lee
- Department of Thoracic and Cardiovascular Surgery, Bucheon Sejong Hospital, Bucheon, Gyeonggi-do, Republic of Korea
| | - Jihoon Kim
- Department of Thoracic and Cardiovascular Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jong Hyun Lee
- Department of Anesthesiology and Pain Medicine, Bucheon Sejong Hospital, Bucheon, Gyeonggi-do, Republic of Korea
| | - Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Bucheon Sejong Hospital, Bucheon, Gyeonggi-do, Republic of Korea.
| |
Collapse
|
11
|
Gardner-Hilbert EF, Gómez-Sánchez M, Lumbreras-Márquez MI, Díaz-Moreno I. Incidence of Clinical Outcomes in Minimally Invasive Valvular Surgery at the Ignacio Chávez National Institute of Cardiology. Cureus 2024; 16:e69859. [PMID: 39435200 PMCID: PMC11493325 DOI: 10.7759/cureus.69859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2024] [Indexed: 10/23/2024] Open
Abstract
Minimally invasive cardiac valve replacement surgery (MICS) is a technique that has reported equivalent rates of mortality and reintervention when compared to conventional median sternotomy (CS). Additionally, MICS has inconsistently been reported to be associated with fewer postoperative complications, better cosmetic outcomes, and shorter hospital stays at the expense of longer surgical time, aortic clamp time, and extracorporeal circulation time. When comparing populations undergoing MICS vs CS at the Ignacio Chávez National Institute of Cardiology (INCICh), it was proven that there is a longer surgical, extracorporeal circulation, and aortic clamp durations in the MICS intervention, but no statistically significant difference in global mortality. MICS was also associated with a shorter hospital stay and less surgical discomfort. MICS can be considered an alternative and equivalent approach to CS for patients undergoing aortic and mitral valve replacement surgery in the Mexican population.
Collapse
Affiliation(s)
| | - Mario Gómez-Sánchez
- Cardiothoracic Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MEX
| | | | | |
Collapse
|
12
|
Maekawa K, Yamanaka S, Onga Y, Takahashi S, Kanamori T. The reimplantation of anomalous aortic origin of the right coronary artery under lower mini-sternotomy. J Surg Case Rep 2024; 2024:rjae528. [PMID: 39183792 PMCID: PMC11341146 DOI: 10.1093/jscr/rjae528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/02/2024] [Accepted: 08/07/2024] [Indexed: 08/27/2024] Open
Abstract
The patient was 28-year-old male. He was suffered from chest pain at rest. He was diagnosed with AAORCA (anomalous aortic origin of the right coronary artery) by emergency catheter. Myocardial scintigraphy indicated ischemic changes in the right coronary artery region, so surgery was the plan. Reimplantation was selected because the coronary artery computed tomography showed little intramural travel and mild coronary artery stenosis. The surgery was performed under lower mini-sternotomy to facilitate early return to work. The patient had a good postoperative course, and was discharged from the hospital postoperative Day 11 after rehabilitation. We report a case of the right coronary artery reimplantation with lower mini-sternotomy for AAORCA.
Collapse
Affiliation(s)
- Koki Maekawa
- Department of Cardiovascular Surgery, Kawaguchi Cardiovascular and Respiratory Hospital, 1-1-51, Maekawa, Kawaguchi, Saitama 333-0842, Japan
| | - Shota Yamanaka
- Department of Cardiovascular Surgery, Kawaguchi Cardiovascular and Respiratory Hospital, 1-1-51, Maekawa, Kawaguchi, Saitama 333-0842, Japan
| | - Yohe Onga
- Department of Cardiovascular Surgery, Kawaguchi Cardiovascular and Respiratory Hospital, 1-1-51, Maekawa, Kawaguchi, Saitama 333-0842, Japan
| | - Shu Takahashi
- Department of Cardiovascular Surgery, Kawaguchi Cardiovascular and Respiratory Hospital, 1-1-51, Maekawa, Kawaguchi, Saitama 333-0842, Japan
| | - Taro Kanamori
- Department of Cardiovascular Surgery, Kawaguchi Cardiovascular and Respiratory Hospital, 1-1-51, Maekawa, Kawaguchi, Saitama 333-0842, Japan
| |
Collapse
|
13
|
Spadaccio C, Nenna A, Pisani A, Laskawski G, Nappi F, Moon MR, Biancari F, Jassar AS, Greason KL, Shrestha ML, Bonaros N, Rose D. Sutureless Valves, a "Wireless" Option for Patients With Aortic Valve Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:382-407. [PMID: 39019533 DOI: 10.1016/j.jacc.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/21/2024] [Accepted: 05/03/2024] [Indexed: 07/19/2024]
Abstract
Transcatheter technologies triggered the recent revision of the guidelines that progressively widened the indications for the treatment of aortic stenosis. On the surgical realm, a technology avoiding the need for sutures to anchor the prosthesis to the aortic annulus has been developed with the aim to reduce the duration of cardiopulmonary bypass and simplify the process of valve implantation. In addition to a transcatheter aortic valve replacement (TAVR)-like stent that exerts a radial force, these so-called "rapid deployment valves" or "sutureless valves" for aortic valve replacement also have cuffs to improve sealing and reduce the risk of paravalvular leak. Despite promising, the actual advantage of sutureless valves over traditional surgical procedures (surgical aortic valve replacement) or TAVR is still debated. This review summarizes the current comparative evidence reporting outcomes of "sutureless valves" for aortic valve replacement to TAVR and surgical aortic valve replacement in the treatment of aortic valve stenosis.
Collapse
Affiliation(s)
- Cristiano Spadaccio
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom; Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Antonio Nenna
- Cardiovascular Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Angelo Pisani
- Cardiac Surgery, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Grzegorz Laskawski
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Marc R Moon
- Cardiothoracic Surgery, Baylor College of Medicine/Texas Heart Institute, Houston, Texas, USA
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital/University of Helsinki, Helsinki, Finland
| | - Arminder S Jassar
- Cardiac Surgery, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
| | - Kevin L Greason
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Malakh L Shrestha
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA; Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany
| | - Nikolaos Bonaros
- Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - David Rose
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom
| |
Collapse
|
14
|
Khalid S, Hassan M, Ali A, Anwar F, Siddiqui MS, Shrestha S. Minimally invasive approaches versus conventional sternotomy for aortic valve replacement in patients with aortic valve disease: a systematic review and meta-analysis of 17 269 patients. Ann Med Surg (Lond) 2024; 86:4005-4014. [PMID: 38989160 PMCID: PMC11230795 DOI: 10.1097/ms9.0000000000002204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/30/2024] [Indexed: 07/12/2024] Open
Abstract
Background Aortic valve replacement (AVR) is a common procedure for aortic valve pathologies, particularly in the elderly. While traditional open AVR is established, minimally invasive techniques aim to reduce morbidity and enhance treatment outcomes. The authors' meta-analysis compares these approaches with conventional sternotomy, offering insights into short and long-term mortality and postoperative results. This study provides valuable evidence for informed decision-making between conventional and minimally invasive approaches for AVR. Materials and methods Till August 2023, PubMed, Embase, and MEDLINE databases were searched for randomized controlled trials (RCT) and propensity score matched (PSM) studies comparing minimally invasive approaches [mini-sternotomy (MS) and right mini-thoracotomy (RMT)] with full sternotomy (FS) for AVR. Various outcomes were analyzed, including mortality rates, bypass and clamp times, length of hospital stay, and complications. Risk ratios (RR) and the weighted mean differences (WMD) with corresponding 95% CIs were calculated using Review Manager. Results Forty-eight studies were included having 17 269 patients in total. When compared to FS, there was no statistically significant difference in in-hospital mortality in MS (RR:0.80; 95% CI:0.50-1.27; I2=1%; P=0.42) and RMT (RR:0.70; 95% CI:0.36-1.35; I2=0%; P=0.29). FS was also linked with considerably longer cardiopulmonary bypass duration than MS (MD:8.68; 95% CI:5.81-11.56; I2=92%; P=0.00001). The hospital length of stay was determined to be shorter in MS (MD:-0.58; 95% CI:-1.08 to -0.09; I2=89%; P=0.02) with no statistically significant difference in RMT (MD:-0.67; 95% CI:-1.42 to 0.08; I2=84%; P=0.08) when compared to FS. Conclusions While mortality rates were comparable in minimally invasive approaches and FS, analysis shows that MS, due to fewer respiratory and renal insufficiencies, as well as shorter hospital and ICU stay, may be a safer approach than both RMT and FS.
Collapse
Affiliation(s)
- Saad Khalid
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Hassan
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Abraish Ali
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Farah Anwar
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Sunita Shrestha
- Upendra Devkota Memorial National Institute of Neurological and Allied Sciences Bansbari, Kathmandu, Nepal
| |
Collapse
|
15
|
Bratt S, Dimberg A, Kastengren M, Lilford RD, Svenarud P, Sartipy U, Franco-Cereceda A, Dalén M. Bleeding in minimally invasive versus conventional aortic valve replacement. J Cardiothorac Surg 2024; 19:349. [PMID: 38907320 PMCID: PMC11191138 DOI: 10.1186/s13019-024-02667-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/20/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Observational studies have shown reduced perioperative bleeding in patients undergoing minimally invasive, compared with full sternotomy, aortic valve replacement. Data from randomized trials are conflicting. METHODS This was a Swedish single center study where adult patients with aortic stenosis, 100 patients were randomly assigned in a 1:1 ratio to undergo either minimally invasive (ministernotomy) or full sternotomy aortic valve replacement. The primary outcome was severe or massive bleeding defined by the Universal Definition of Perioperative Bleeding in adult cardiac surgery (UDPB). Secondary outcomes included blood product transfusions, chest tube output, re-exploration for bleeding, and several other clinically relevant events. RESULTS Out of 100 patients, three patients randomized to ministernotomy were intraoperatively converted to full sternotomy (none was bleeding-related). Three patients (6%) in the full sternotomy group and 3 patients (6%) in the ministernotomy group suffered severe or massive postoperative bleeding according to the UDPB definition (p = 1.00). Mean chest tube output during the first 12 postoperative hours was 350 (standard deviation (SD) 220) ml in the full sternotomy group and 270 (SD 190) ml in the ministernotomy group (p = 0.08). 28% of patients in the full sternotomy group and 36% of patients in the ministernotomy group received at least one packed red blood cells transfusion (p = 0.39). Two patients in each group (4%) underwent re-exploration for bleeding. CONCLUSIONS Minimally invasive aortic valve replacement did not result in less bleeding-related outcomes compared to full sternotomy. CLINICAL TRIAL REGISTRATION http://www. CLINICALTRIALS gov . Unique identifier: NCT02272621.
Collapse
Affiliation(s)
- Sorosh Bratt
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, SE-17176, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Axel Dimberg
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, SE-17176, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Kastengren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Robert D Lilford
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, SE-17176, Sweden
| | - Peter Svenarud
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, SE-17176, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, SE-17176, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, SE-17176, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Dalén
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, SE-17176, Sweden.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
16
|
Hlavicka J, Gettwart L, Landgraf J, Salem R, Hecker F, Salihi E, Van Linden A, Walther T, Holubec T. Minimally Invasive and Full Sternotomy Aortic Valve Replacements Lead to Comparable Long-Term Outcomes in Elderly Higher-Risk Patients: A Propensity-Matched Comparison. J Cardiovasc Dev Dis 2024; 11:112. [PMID: 38667730 PMCID: PMC11050264 DOI: 10.3390/jcdd11040112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Minimally invasive aortic valve replacement (AVR) via upper ministernotomy (MiniAVR) is a standard alternative to full sternotomy access. Minimally invasive cardiac surgery has been proven to provide a number of benefits to patients. The aim of this study was to compare the short- and long-term outcomes after MiniAVR versus conventional AVR via full sternotomy (FS) using a biological prosthesis in an elderly higher-risk population. METHODS Between January 2006 and July 2009, 918 consecutive patients received AVR ± additional procedures with different prostheses at our center. Amongst them, 441 received isolated AVR using a biological prosthesis (median age of 74.5; range: 52-93 years; 50% females) and formed the study population (EuroSCORE II: 3.62 ± 5.5, range: 0.7-42). In total, 137 (31.1%) of the operations were carried out through FS, and 304 (68.9%) were carried out via MiniAVR. Follow-up was complete in 96% of the cases (median of 7.6 years, 6610 patient-years). Propensity score matching (PSM) resulted in two groups of 68 patients with very similar baseline profiles. The primary endpoints were long-term survival, freedom from reoperation, and endocarditis, and the secondary endpoints were early major adverse cardiac and cerebrovascular events (MACCEs). RESULTS FS led to shorter cardio-pulmonary bypass and aortic cross-clamp durations: 90 (47-194) vs. 100 (46-246) min (p = 0.039) and 57 (33-156) vs. 69 (32-118) min (p = 0.006), respectively. Perioperative stroke occurred in three patients (4.4%; FS) vs. one patient (1.5%; MiniAVR) (p = 0.506). The 30-day mortality was similar in both groups (2.9%, p = 1.000). Survival at 1, 5, and 10 years was 94.1 ± 3% (FS and MiniAVR), 80.3 ± 5% vs. 75.7 ± 5%, and 45.3 ± 6% vs. 43.8 ± 6%, respectively (p = 0.767). There were two (2.9%) reoperations in each group and two thrombo-embolic events (2.9%) vs. one (1.5%) thrombo-embolic event in the MiniAVR and FS groups, respectively (p = 0.596). CONCLUSIONS In comparison to FS, MiniAVR provided similar short- and long-term outcomes in a higher-risk elderly population receiving biological prostheses. In particular, long-term survival, freedom from reoperation, and the incidence of endocarditis were comparable. These results clearly advocate for the routine use of MiniAVR as a standard procedure for AVR, even in a high-risk population.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Tomas Holubec
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60596 Frankfurt/Main, Germany; (J.H.); (L.G.); (J.L.); (R.S.); (F.H.); (E.S.); (A.V.L.); (T.W.)
| |
Collapse
|
17
|
Awad AK, Ahmed A, Mathew DM, Varghese KS, Mathew SM, Khaja S, Newell PC, Okoh AK, Hirji S. Minimally invasive, surgical, and transcatheter aortic valve replacement: A network meta-analysis. J Cardiol 2024; 83:177-183. [PMID: 37611742 DOI: 10.1016/j.jjcc.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has evolved as an alternative to surgical aortic valve replacement (SAVR). In addition to full-sternotomy (FS), recent reports have shown successful minimally-invasive SAVR approaches, including mini-sternotomy (MS) and mini-thoracotomy (MT). This network-meta-analysis (NMA) seeks to provide an outcomes comparison based on these different modalities (MS, MT, TAVR) compared with FS as a reference arm for the management of aortic valve disease. METHODS A comprehensive literature search was performed to identify studies that compared minimally-invasive SAVR (MS/MT) to conventional FS-SAVR, and/or TAVR. Bayesian NMA was performed using the random effects model. Outcomes were pooled as risk ratios (RR) with their 95 % confidence intervals (CIs). Our primary outcomes included 30-day mortality, stroke, acute kidney injury (AKI), major bleeding, new permanent pacemaker (PPM), and paravalvular leak (PVL). We also assessed long-term mortality at the latest follow-up. RESULTS A total of 27,117 patients (56 studies) were included; 10,397 patients had FS SAVR, 9523 had MS, 5487 had MT, and 1710 had TAVR. Compared to FS, MS was associated with statistically-significantly lower rates of 30-day mortality (RR, 0.76, 95%CI 0.59-0.98), stroke (RR, 0.84, 95%CI 0.72-0.97), AKI (RR, 0.76, 95%CI 0.61-0.94), and long-term mortality (RR 0.84, 95%CI 0.72-0.97) at a weighted mean follow-up duration of 10.4 years, while MT showed statistically-significantly higher rates of 30-day PVL (RR, 3.76, 95%CI 1.31-10.85) and major bleeding (RR 1.45; 95%CI 1.08-1.94). TAVR had statistically significant lower rates of 30-day AKI (RR 0.49, 95%CI 0.31-0.77), but showed statistically-significantly higher PPM (RR 2.50; 95%CI 1.60-3.91) and 30-day PVL (RR 12.85, 95%CI 5.05-32.68) compared to FS. CONCLUSIONS MS was protective against 30-day mortality, stroke, AKI, and long-term mortality compared to FS; TAVR showed higher rates of 30-day PVL and PPM but was protective against AKI. Conversely, MT showed higher rates of 30-day PVL and major bleeding. With the emergence of TAVR, the appropriate benchmarks for SAVR comparison in future trials should be the minimally-invasive SAVR approaches to provide clinical equipoise.
Collapse
Affiliation(s)
- Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Adham Ahmed
- City University of New York School of Medicine, New York, NY, USA
| | - Dave M Mathew
- City University of New York School of Medicine, New York, NY, USA
| | | | - Serena M Mathew
- City University of New York School of Medicine, New York, NY, USA
| | - Sofia Khaja
- City University of New York School of Medicine, New York, NY, USA
| | - Paige C Newell
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Sameer Hirji
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
18
|
Elghannam M, Useini D, Moustafine V, Bechtel M, Naraghi H, Strauch JT, Haldenwang PL. Minimally Invasive versus Conventional Aortic Root Surgery: Results of an Intermediate-Volume Center. Thorac Cardiovasc Surg 2024; 72:118-125. [PMID: 37040869 DOI: 10.1055/a-2041-3695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND We evaluate the outcome of aortic root surgery via an upper J: -shaped mini-sternotomy (MS) versus full sternotomy (FS) in an intermediate-volume center. METHODS Between November 2011 and February 2019, 94 consecutive patients underwent aortic root surgery: 62 (66%) patients were operated via a J: -shaped MS (group A) and 32 (34%) patients via FS (group B). The primary endpoints were mortality, major adverse cardiac and cerebral events (MACCE), and reoperation in a 2-year follow-up. The secondary endpoints were perioperative complications and patient's satisfaction with the procedural results. RESULTS Valve sparing root replacement (David procedure) was performed in 13 (21%) of the MS and 7 (22%) of the FS patients. The Bentall procedure in MS versus FS was 49 (79%) versus 25 (78%), respectively. Both groups presented similar mean operation, cardiopulmonary bypass, and cross-clamp times. Postoperative bleeding was 534 ± 300 and 755 ± 402 mL (p = 0.01) in MS and FS, respectively, erythrocyte concentrate substitution was 3 ± 3 and 5.3 ± 4.8 (p = 0.018) in MS and FS, respectively, and pneumonia rates were 0 and 9.4% (p = 0.03) in MS and FS, respectively. The 30-day mortality was 0% in both groups, whereas MACCE was 1.6 and 3% (p = 0.45) in MS and FS, respectively. After 2 years, the mortality and MACCE were 4.6 and 9.5% (p = 0.11) and 4.6 and 0% (p = 0.66) in MS and FS, respectively. The number of patients who were satisfied with the surgical cosmetic results in groups A and B was 53 (85.4%) and 26 (81%), respectively. CONCLUSION Aortic root surgery via MS is a safe alternative to FS even in an intermediate-volume center. It offers a shorter recovery time and similar midterm results.
Collapse
Affiliation(s)
- Mahmoud Elghannam
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Dritan Useini
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Hamid Naraghi
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Justus T Strauch
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| |
Collapse
|
19
|
Cammertoni F, Bruno P, Pavone N, Nesta M, Chiariello GA, Grandinetti M, D’Avino S, Sanesi V, D’Errico D, Massetti M. Outcomes of Minimally Invasive Aortic Valve Replacement in Obese Patients: A Propensity-Matched Study. Braz J Cardiovasc Surg 2024; 39:e20230159. [PMID: 38426432 PMCID: PMC10903361 DOI: 10.21470/1678-9741-2023-0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/30/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Obese patients are at risk of complications after cardiac surgery. The aim of this study is to investigate safety and efficacy of a minimally invasive approach via upper sternotomy in this setting. METHODS We retrospectively reviewed 203 obese patients who underwent isolated, elective aortic valve replacement between January 2014 and January 2023 - 106 with minimally invasive aortic valve replacement (MIAVR) and 97 with conventional aortic valve replacement (CAVR). To account for baseline differences, a propensity-matching analysis was performed obtaining two balanced groups of 91 patients each. RESULTS The 30-day mortality rate was comparable between groups (1.1% MIAVR vs. 0% CAVR, P=0.99). MIAVR patients had faster extubation than CAVR patients (6 ± 2 vs. 9 ± 2 hours, P<0.01). Continuous positive airway pressure therapy was less common in the MIAVR than in the CAVR group (3.3% vs. 13.2%, P=0.03). Other postoperative complications did not differ significantly. Intensive care unit stay (1.8 ± 1.2 vs. 3.2 ± 1.4 days, P<0.01), but not hospital stay (6.7 ± 2.1 vs. 7.2 ± 1.9 days, P=0.09), was shorter for MIAVR than for CAVR patients. Follow-up survival was comparable (logrank P-value = 0.58). CONCLUSION MIAVR via upper sternotomy has been shown to be a safe and effective option for obese patients. Respiratory outcome was promising with shorter mechanical ventilation time and reduced need for post-extubation support. The length of stay in the intensive care unit was reduced. These advantages might be important for the obese patient to whom minimally invasive surgery should not be denied.
Collapse
Affiliation(s)
- Federico Cammertoni
- Department of Cardiovascular Sciences, Cardiac Surgery Unit,
Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Sciences, Cardiac Surgery Unit,
Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Natalia Pavone
- Department of Cardiovascular Sciences, Cardiac Surgery Unit,
Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marialisa Nesta
- Department of Cardiovascular Sciences, Cardiac Surgery Unit,
Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Alfonso Chiariello
- Department of Cardiovascular Sciences, Cardiac Surgery Unit,
Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Grandinetti
- Department of Cardiovascular Sciences, Cardiac Surgery Unit,
Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Denise D’Errico
- Department of Cardiovascular Sciences, Perfusion Unit, Fondazione
Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Cardiac Surgery Unit,
Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
20
|
Malaisrie SC, Mumtaz MA, Barnhart GR, Chitwood R, Ryan WH, Accola KD, Patel HJ, Woo YJ, Dewey TM, Koulogiannis K, Dorsey MP, Grossi EA. Midterm outcomes of aortic valve replacement using a rapid-deployment valve for aortic stenosis: TRANSFORM trial. JTCVS OPEN 2024; 17:55-63. [PMID: 38420551 PMCID: PMC10897657 DOI: 10.1016/j.xjon.2023.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/12/2023] [Accepted: 10/26/2023] [Indexed: 03/02/2024]
Abstract
Background The use of rapid-deployment valves (RDVs) has been shown to reduce the operative time for surgical aortic valve replacement (AVR). Long-term core laboratory-adjudicated data are scarce, however. Here we report final 7-year data on RDV use. Methods TRANSFORM was a prospective, nonrandomized, multicenter, single-arm trial implanting a stented bovine pericardial valve with an incorporated balloon-expandable sealing frame. A prior published 1-year analysis included 839 patients from 29 centers. An additional 46 patients were enrolled and implanted, for a total of 885 patients. Annual clinical and core laboratory-adjudicated echocardiographic outcomes were collected through 8 years. Primary endpoints were structural valve deterioration (SVD), all-cause reintervention, all-cause valve explantation, and all-cause mortality. Secondary endpoints included hemodynamic performance assessed by echocardiography. The mean duration of follow-up was 5.0 ± 2.0 years. Results The mean patient age was 73.3 ± 8.2 years. Isolated AVR was performed in 62.1% of the patients, and AVR with concomitant procedures was performed in 37.9%. Freedom from all-cause mortality at 7 years was 76.0% for isolated AVR and 68.2% for concomitant AVR. Freedom from SVD, all-cause reintervention, and valve explantation at 7 years was 97.5%, 95.7%, and 97.8%, respectively. The mean gradient and effective orifice area at 7 years were 11.1 ± 5.3 mm Hg and 1.6 ± 0.3 cm2, respectively. Paravalvular leak at 7 years was none/trace in 88.6% and mild in 11.4%. In patients undergoing isolated AVR, the cumulative probability of pacemaker implantation was 13.9% at 30 days, 15.5% at 1 year, and 21.8% at 7 years. Conclusions AVR for aortic stenosis using an RDV is associated with low rates of late adverse events. This surgical pericardial tissue platform provides excellent and stable hemodynamic performance through 7 years.
Collapse
Affiliation(s)
| | - Mubashir A Mumtaz
- Department of Cardiovascular and Thoracic Surgery, University of Pittsburgh Medical Center Harrisburg, Harrisburg, Pa
| | - Glenn R Barnhart
- Structural Heart Program, Swedish Heart and Vascular Institute, Seattle, Wash
| | - Randolph Chitwood
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC
| | - William H Ryan
- Cardiac Surgery Specialists, Baylor Plano Heart Hospital, Plano, Tex
| | - Kevin D Accola
- Florida Hospital Cardiovascular Institute, Florida Hospital Orlando, Orlando, Fla
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, Calif
| | | | | | - Michael P Dorsey
- Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, NY
| | - Eugene A Grossi
- Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, NY
| |
Collapse
|
21
|
Kirmani BH, Jones SG, Muir A, Malaisrie SC, Chung DA, Williams RJ, Akowuah E. Limited versus full sternotomy for aortic valve replacement. Cochrane Database Syst Rev 2023; 12:CD011793. [PMID: 38054555 PMCID: PMC10698838 DOI: 10.1002/14651858.cd011793.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Aortic valve disease is a common condition easily treatable with cardiac surgery. This is conventionally performed by opening the sternum ('median sternotomy') and replacing the valve under cardiopulmonary bypass. Median sternotomy is well tolerated, but as less invasive options become available, the efficacy of limited incisions has been called into question. In particular, the effects of reducing the visibility and surgical access have raised safety concerns with regard to the placement of cannulae, venting of the heart, epicardial wire placement, and de-airing of the heart at the end of the procedure. These difficulties may increase operating times, affecting outcome. The benefits of smaller incisions are thought to include decreased pain; improved respiratory mechanics; reductions in wound infections, bleeding, and need for transfusion; shorter intensive care stay; better cosmesis; and a quicker return to normal activity. This is an update of a Cochrane review first published in 2017, with seven new studies. OBJECTIVES To assess the effects of minimally invasive aortic valve replacement via a limited sternotomy versus conventional aortic valve replacement via median sternotomy in people with aortic valve disease requiring surgical replacement. SEARCH METHODS We performed searches of CENTRAL, MEDLINE and Embase from inception to August 2021, with no language limitations. We also searched two clinical trials registries and manufacturers' websites. We reviewed references of primary studies to identify any further studies of relevance. SELECTION CRITERIA We included randomised controlled trials comparing aortic valve replacement via a median sternotomy versus aortic valve replacement via a limited sternotomy. We excluded trials that performed other minimally invasive incisions such as mini-thoracotomies, port access, transapical, transfemoral or robotic procedures. Although some well-conducted prospective and retrospective case-control and cohort studies exist, these were not included in this review. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial papers to extract data, assess quality, and identify risk of bias. A third review author provided arbitration where required. We determined the certainty of evidence using the GRADE methodology and summarised results of patient-relevant outcomes in a summary of findings table. MAIN RESULTS The review included 14 trials with 1395 participants. Most studies had at least two domains at high risk of bias. We analysed 14 outcomes investigating the effects of minimally invasive limited upper hemi-sternotomy on aortic valve replacement as compared to surgery performed via full median sternotomy. Upper hemi-sternotomy may have little to no effect on mortality versus full median sternotomy (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.45 to 1.94; 10 studies, 985 participants; low-certainty evidence). Upper hemi-sternotomy for aortic valve replacement may increase cardiopulmonary bypass time slightly, although the evidence is very uncertain (mean difference (MD) 10.63 minutes, 95% CI 3.39 to 17.88; 10 studies, 1043 participants; very low-certainty evidence) and may increase aortic cross-clamp time slightly (MD 6.07 minutes, 95% CI 0.79 to 11.35; 12 studies, 1235 participants; very low-certainty evidence), although the evidence is very uncertain. Most studies had at least two domains at high risk of bias. Postoperative blood loss was probably lower in the upper hemi-sternotomy group (MD -153 mL, 95% CI -246 to -60; 8 studies, 767 participants; moderate-certainty evidence). Low-certainty evidence suggested that there may be no change in pain scores by upper hemi-sternotomy (standardised mean difference (SMD) -0.19, 95% CI -0.43 to 0.04; 5 studies, 649 participants). Upper hemi-sternotomy may result in little to no difference in quality of life (MD 0.03 higher, 95% CI 0 to 0.06 higher; 4 studies, 624 participants; low-certainty evidence). Two studies reporting index admission costs concluded that limited sternotomy may be more costly at index admission in the UK National Health Service (MD 1190 GBP more, 95% CI 420 GBP to 1970 GBP, 2 studies, 492 participants; low-certainty evidence). AUTHORS' CONCLUSIONS The evidence was of very low to moderate certainty. Sample sizes were small and underpowered to demonstrate differences in some outcomes. Clinical heterogeneity was also noted. Considering these limitations, there may be little to no effect on mortality. Differences in extracorporeal support times are uncertain, comparing upper hemi-sternotomy to full sternotomy for aortic valve replacement. Before widespread adoption of the minimally invasive approach can be recommended, there is a need for a well-designed and adequately powered prospective randomised controlled trial. Such a study would benefit from also performing a robust cost analysis. Growing patient preference for minimally invasive techniques merits thorough quality of life analyses to be included as end points, as well as quantitative measures of physiological reserve.
Collapse
Affiliation(s)
- Bilal H Kirmani
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
- University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Sion G Jones
- Department of Cardiac Surgery, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Andrew Muir
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Northwestern University, Chicago, IL, USA
| | | | | | - Enoch Akowuah
- Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| |
Collapse
|
22
|
Ilcheva L, Risteski P, Tudorache I, Häussler A, Papadopoulos N, Odavic D, Rodriguez Cetina Biefer H, Dzemali O. Beyond Conventional Operations: Embracing the Era of Contemporary Minimally Invasive Cardiac Surgery. J Clin Med 2023; 12:7210. [PMID: 38068262 PMCID: PMC10707549 DOI: 10.3390/jcm12237210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/18/2023] [Accepted: 11/18/2023] [Indexed: 06/26/2024] Open
Abstract
Over the past two decades, minimally invasive cardiac surgery (MICS) has gained a significant place due to the emergence of innovative tools and improvements in surgical techniques, offering comparable efficacy and safety to traditional surgical methods. This review provides an overview of the history of MICS, its current state, and its prospects and highlights its advantages and limitations. Additionally, we highlight the growing trends and potential pathways for the expansion of MICS, underscoring the crucial role of technological advancements in shaping the future of this field. Recognizing the challenges, we strive to pave the way for further breakthroughs in minimally invasive cardiac procedures.
Collapse
Affiliation(s)
- Lilly Ilcheva
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
| | - Petar Risteski
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Achim Häussler
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Nestoras Papadopoulos
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Dragan Odavic
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Hector Rodriguez Cetina Biefer
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| |
Collapse
|
23
|
Irace FG, Chirichilli I, Russo M, Ranocchi F, Bergonzini M, Lio A, Nicolò F, Musumeci F. Aortic Valve Replacement: Understanding Predictors for the Optimal Ministernotomy Approach. J Clin Med 2023; 12:6717. [PMID: 37959183 PMCID: PMC10647482 DOI: 10.3390/jcm12216717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION The most common minimally invasive approach for aortic valve replacement (AVR) is the partial upper mini-sternotomy. The aim of this study is to understand which preoperative computed tomography (CT) features are predictive of longer operations in terms of cardio-pulmonary bypass timesand cross-clamp times. METHODS From 2011 to 2022, we retrospectively selected 246 patients which underwent isolated AVR and had a preoperative ECG-gated CT scan. On these patients, we analysed the baseline anthropometric characteristics and the following CT scan parameters: aortic annular dimensions, valve calcium score, ascending aorta length, ascending aorta inclination and aorta-sternum distance. RESULTS We identified augmented body surface area (>1.9 m2), augmented annular diameter (>23 mm), high calcium score (>2500 Agatson score) and increased aorta-sternum distance (>30 mm) as independent predictors of elongated operation times (more than two-fold). CONCLUSIONS Identifying the preoperative predictive factors of longer operations can help surgeons select cases suitable for minimally invasive approaches, especially in a teaching context.
Collapse
Affiliation(s)
| | | | - Marco Russo
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Viale Gianicolense 87, 00151 Rome, Italy (A.L.); (F.M.)
| | | | | | | | | | | |
Collapse
|
24
|
Li J, Li Z, Dong P, Liu P, Xu Y, Fan Z. Effects of parasternal intercostal block on surgical site wound infection and pain in patients undergoing cardiac surgery: A meta-analysis. Int Wound J 2023; 21:e14433. [PMID: 37846438 PMCID: PMC10828712 DOI: 10.1111/iwj.14433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023] Open
Abstract
This study aimed to assess the effect of parasternal intercostal block on postoperative wound infection, pain, and length of hospital stay in patients undergoing cardiac surgery. PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang databases were extensively queried using a computer, and randomised controlled studies (RCTs) from the inception of each database to July 2023 were sought using keywords in English and Chinese language. Literature quality was assessed using Cochrane-recommended tools, and the included data were collated and analysed using Stata 17.0 software for meta-analysis. Ultimately, eight RCTs were included. Meta-analysis revealed that utilising parasternal intercostal block during cardiac surgery significantly reduced postoperative wound pain (standardised mean difference [SMD] = -1.01, 95% confidence intervals [CI]: -1.70 to -0.31, p = 0.005) and significantly shortened hospital stay (SMD = -0.40, 95% CI: -0.77 to -0.04, p = 0.029), though it may increase the risk of wound infection (OR = 5.03, 95% CI:0.58-44.02, p = 0.144); however, the difference was not statistically significant. The application of parasternal intercostal block during cardiac surgery can significantly reduce postoperative pain and shorten hospital stay. This approach is worth considering for clinical implementation. Decisions regarding its adoption should be made in conjunction with the relevant clinical indices and surgeon's experience.
Collapse
Affiliation(s)
- Jian‐Qiang Li
- Department of Cardiac SurgeryYantai Yuhuangding HospitalYantaiChina
| | - Zhen‐Hui Li
- Department of AnesthesiologyQingdao Fuwai HospitalQingdaoChina
| | - Ping Dong
- Department of HematologyYantai Yuhuangding HospitalYantaiChina
| | - Peng Liu
- Department of Cardiac Surgery ICUYantai Yuhuangding HospitalYantaiChina
| | - Ying‐Zhen Xu
- Department of AnesthesiologyQingdao Fuwai HospitalQingdaoChina
| | - Zhi‐Jun Fan
- Department of Cardiac SurgeryQingdao Fuwai HospitalQingdaoChina
| |
Collapse
|
25
|
Yun T, Kim KH, Sohn SH, Kang Y, Kim JS, Choi JW. Rapid-Deployment Aortic Valve Replacement in a Real-World All-Comers Population. Thorac Cardiovasc Surg 2023; 71:511-518. [PMID: 36216332 DOI: 10.1055/s-0042-1757241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND This study was conducted to evaluate the mid-term outcomes of rapid-deployment aortic valve replacement (AVR) using Edwards Intuity. METHODS A total of 215 patients underwent rapid-deployment AVR using Edwards Intuity at our institution. The median follow-up duration was 22 months (interquartile range, 8-36). Primary outcomes were overall survival, cumulative incidence of cardiac death, and major adverse cardiac events. Secondary outcomes were early and 1-year hemodynamic performances of the bioprosthetic valve. RESULTS The mean age was 68.6 ± 10.5 years, and EuroSCORE II was 3.09 ± 4.5. The study population included 113 patients (52.6%) with bicuspid valves (24 patients with type 0 bicuspid valves), 20 patients (9.3%) with pure aortic regurgitation, and 3 patients (1.4%) with infective endocarditis. Isolated AVR was performed in 70 patients (32.4%) and concomitant procedures were performed in 146 patients (67.6%), including aorta surgery (42.3%) and mitral valve procedure (22.3%). Operative mortality was 2.8%. Complete atrioventricular block occurred in 12 patients, but most of them were transient and only 3 patients received permanent pacemaker implantation before discharge. Overall survival at 3 years was 92.3%. Early hemodynamic data showed mean pressure gradients of 15.5 ± 5.0 and 12.7 ± 4.2 mm Hg in the 19 and 21 mm valve, respectively. One-year hemodynamics were also excellent with mean pressure gradients of 14.7 ± 5.3 and 10.7 ± 3.6 mm Hg in the 19 and 21 mm valve, respectively. CONCLUSION Based on a real-world all-comers population, rapid-deployment AVR using Edwards Intuity could be performed for various indications, including bicuspid valve, pure aortic regurgitation, and infective endocarditis, and the clinical and hemodynamic outcomes were excellent.
Collapse
Affiliation(s)
- Taeyoung Yun
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
26
|
Gerfer S, Eghbalzadeh K, Brinkschröder S, Djordjevic I, Rustenbach C, Rahmanian P, Mader N, Kuhn E, Wahlers T. Is It Reasonable to Perform Isolated SAVR by Residents in the TAVI Era? Thorac Cardiovasc Surg 2023; 71:376-386. [PMID: 34808679 DOI: 10.1055/s-0041-1736206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The role of conventional surgical aortic valve replacement (SAVR) is increasingly questioned since the indication for transcatheter aortic valve implantations (TAVIs) is currently extended. While the number of patients referred to SAVR decreases, it is unclear if SAVR should be performed by junior resident surgeons in the course of a heart surgeons training. METHODS Patients with isolated aortic valve replacement (AVR) were analyzed with respect to the surgeon's qualification. AVR performed by resident surgeons was compared with AVR by senior surgeons. The collective was analyzed with respect to clinical short-term outcomes comparing full sternotomy (FS) with minimally invasive surgery and ministernotomy (MS) with right anterior thoracotomy (RAT) after a 1:1 propensity score matching. RESULTS The 30-day all-cause mortality was 2.3 and 3.4% for resident versus senior AVR groups, cerebrovascular event rates were 1.1 versus 2.6%, and no cases of significant paravalvular leak were detected. Clinical short-term outcomes between FS and minimally invasive access, as well after MS and RAT were comparable. CONCLUSION Our current data show feasibility and safety of conventional SAVR procedure performed by resident surgeons in the era of TAVI. Minimally invasive surgery should be trained and performed in higher volumes early in the educational process as it is a safe treatment option.
Collapse
Affiliation(s)
- Stephen Gerfer
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Sarah Brinkschröder
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Christian Rustenbach
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Parwis Rahmanian
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| |
Collapse
|
27
|
Issa M, Neumann JO, Al-Maisary S, Dyckhoff G, Kronlage M, Kiening KL, Ishak B, Unterberg AW, Scherer M. Anterior Access to the Cervicothoracic Junction via Partial Sternotomy: A Clinical Series Reporting on Technical Feasibility, Postoperative Morbidity, and Early Surgical Outcome. J Clin Med 2023; 12:4107. [PMID: 37373799 DOI: 10.3390/jcm12124107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Surgical access to the cervicothoracic junction (CTJ) is challenging. The aim of this study was to assess technical feasibility, early morbidity, and outcome in patients undergoing anterior access to the CTJ via partial sternotomy. Consecutive cases with CTJ pathology treated via anterior access and partial sternotomy at a single academic center from 2017 to 2022 were retrospectively reviewed. Clinical data, perioperative imaging, and outcome were assessed with regards to the aims of the study. A total of eight cases were analyzed: four (50%) bone metastases, one (12.5%) traumatic instable fracture (B3-AO-Fracture), one (12.5%) thoracic disc herniation with spinal cord compression, and two (25%) infectious pathologic fractures from tuberculosis and spondylodiscitis. The median age was 49.9 years (range: 22-74 y), with a 75% male preponderance. The median Spinal Instability Neoplastic Score (SINS) was 14.5 (IQR: 5; range: 9-16), indicating a high degree of instability in treated cases. Four cases (50%) underwent additional posterior instrumentation. All surgical procedures were performed uneventfully, with no intraoperative complications. The median length of hospital stay was 11.5 days (IQR: 9; range: 6-20), including a median of 1 day in an intensive care unit (ICU). Two cases developed postoperative dysphagia related to stretching and temporary dysfunction of the recurrent laryngeal nerve. Both cases completely recovered at 3 months follow-up. No in-hospital mortality was observed. The radiological outcome was unremarkable in all cases, with no case of implant failure. One case died due to the underlying disease during follow-up. The median follow-up was 2.6 months (IQR: 23.8; range: 1-45.7 months). Our series indicates that the anterior approach to the cervicothoracic junction and upper thoracic spine via partial sternotomy can be considered an effective option for treatment of anterior spinal pathologies, exhibiting a reasonable safety profile. Careful case selection is essential to adequately balance clinical benefits and surgical invasiveness for these procedures.
Collapse
Affiliation(s)
- Mohammed Issa
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Jan-Oliver Neumann
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Sameer Al-Maisary
- Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Gerhard Dyckhoff
- Department of Otorhinolaryngology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Moritz Kronlage
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Karl L Kiening
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Moritz Scherer
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| |
Collapse
|
28
|
Vohra HA, Salmasi MY, Mohamed F, Shehata M, Bahrami B, Caputo M, Deshpande R, Bapat V, Bahrami T, Birdi I, Zacharias J. Consensus statement on aortic valve replacement via an anterior right minithoracotomy in the UK healthcare setting. Open Heart 2023; 10:e002194. [PMID: 37001910 PMCID: PMC10069572 DOI: 10.1136/openhrt-2022-002194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
The wide uptake of anterior right thoracotomy (ART) as an approach for aortic valve replacement (AVR) has been limited despite initial reports of its use in 1993. Compared with median sternotomy, and even ministernotomy, ART is considered to be less traumatic to the chest wall and to help facilitate quicker patient recovery. In this statement, a consensus agreement is outlined that describes the potential benefits of the ART AVR. The technical considerations that require specific attention are described and the initiation of an ART programme at a UK centre is recommended through simulation and/or use of specialist instruments in conventional cases. The use of soft tissue retractors, peripheral cannulation, modified aortic clamping and the use of intraoperative adjuncts, such as sutureless valves and/or automated knot fasteners, are important to consider in order to circumvent the challenges of minimal the altered exposure via an ART.A coordinated team-based approach that encourages ownership of the programme by team members is critical. A designated proctor/mentor is also recommended. The organisation of structured training and simulation, as well as planning the initial cases are important steps to consider.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Vinayak Bapat
- Cardiovascular Directorate, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | - Inderpaul Birdi
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK
| | - Joseph Zacharias
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| |
Collapse
|
29
|
Jovanovic M, Zivkovic I, Jovanovic M, Bilbija I, Petrovic M, Markovic J, Radovic I, Dimitrijevic A, Soldatovic I. Economic Justification Analysis of Minimally Invasive versus Conventional Aortic Valve Replacement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2553. [PMID: 36767915 PMCID: PMC9916198 DOI: 10.3390/ijerph20032553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
There is no definitive consensus about the cost-effectiveness of minimally invasive aortic valve replacement (AVR) (MI-AVR) compared to conventional AVR (C-AVR). The aim of this study was to compare the rate of postoperative complications and total hospital costs of MI-AVR versus C-AVR overall and by the type of aortic prosthesis (biological or mechanical). Our single-center retrospective study included 324 patients over 18 years old who underwent elective isolated primary AVR with standard stented AV prosthesis at the Institute for Cardiovascular Diseases "Dedinje" between January 2019 and December 2019. Reintervention, emergencies, combined surgical interventions, and patients with sutureless valves were excluded. In both MI-AVR and C-AVR, mechanical valve implantation contributed to overall reduction of hospital costs with equal efficacy. The cost-effectiveness ratio indicated that C-AVR is cheaper and yielded a better clinical outcome with mechanical valve implantation (67.17 vs. 69.5). In biological valve implantation, MI-AVR was superior. MI-AVR patients had statistically significantly higher LVEF and a lower Euro SCORE than C-AVR patients (Mann-Whitney U-test, p = 0.002 and p = 0.002, respectively). There is a slight advantage to MI-AVR vs. C-AVR, since it costs EUR 9.44 more to address complications that may arise. Complications (mortality, early reoperation, cerebrovascular insult, pacemaker implantation, atrial fibrillation, AV block, systemic inflammatory response syndrome, wound infection) were less frequent in the MI-AVR, making MI-AVR more economically justified than C-AVR (18% vs. 22.1%).
Collapse
Affiliation(s)
- Marko Jovanovic
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Igor Zivkovic
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milos Jovanovic
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
| | - Ilija Bilbija
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Cardiac Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Masa Petrovic
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jovan Markovic
- Faculty of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivana Radovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Transfusiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ana Dimitrijevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivan Soldatovic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| |
Collapse
|
30
|
Worku B, Gulkarov I, Gambardella I. Ministernotomy aortic valve replacement: The cost of preference. J Card Surg 2022; 37:4587-4588. [PMID: 36378916 DOI: 10.1111/jocs.17152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Berhane Worku
- Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York, USA.,Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, New York, Brooklyn, USA
| | - Iosif Gulkarov
- Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York, USA.,Department of Cardiothoracic Surgery, New York Presbyterian Queens Hospital, New York, Queens, USA
| | - Ivan Gambardella
- Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York, USA.,Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, New York, Brooklyn, USA
| |
Collapse
|
31
|
El-Andari R, White A, Fialka NM, Shan S, Manikala VK, Hong Y, Wang S. Mini-sternotomy versus full sternotomy for isolated aortic valve replacement: A single-center experience. J Card Surg 2022; 37:4579-4586. [PMID: 36378945 DOI: 10.1111/jocs.17158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/10/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Minimally invasive approaches to isolated aortic valve replacement (AVR) are well-described and widely utilized. While there are numerous proposed benefits, there is limited literature describing significant morbidity or mortality benefits for minimally invasive isolated AVR resulting in hesitancy in its universal adoption. In this retrospective study, we compare the 5-year outcomes of patients undergoing isolated AVR via full sternotomy (FS) or mini-sternotomy (MS). METHODS 756 patients underwent isolated AVR between 2014 and 2019. Propensity matching resulted in 142 matched pairs that received either FS or MS. The primary outcome was mortality during the follow-up period. Secondary outcomes included intraoperative variables and postoperative morbidity. RESULTS Intraoperative variables including total operative, cardiopulmonary bypass, and aortic cross-clamp times did not differ significantly between groups. Postoperative mortality was similar between the matched groups with nonsignificant differences at 30 days (2.12% vs. 1.4%, p = .657), 1 year (4.9% vs. 2.1%, p = .0.223), and 5 years (7.5% vs. 3.5%, p = .174). Rates of postoperative morbidity were comparable between groups with no significant differences. CONCLUSION This study examined the long-term outcomes of propensity-matched patients undergoing isolated AVR via FS or MS and identified no significant differences in outcomes over a 5-year follow-up period. The decision for surgical approach is multifactorial and should be decided on a case-by-case basis taking into consideration patient anatomy, surgeon experience, and comfort, as well as patient preference.
Collapse
Affiliation(s)
- Ryaan El-Andari
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Abigail White
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas M Fialka
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shubham Shan
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Vinod K Manikala
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Yonghze Hong
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Shaohua Wang
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
32
|
Yang Z, Jiang H, Liu Y, Ge Y, Wang H. Both J- and L-shaped upper hemisternotomy approaches are suitable for total arch replacement with frozen elephant trunk in patients with Type A dissection. Front Cardiovasc Med 2022; 9:998139. [PMID: 36440043 PMCID: PMC9687356 DOI: 10.3389/fcvm.2022.998139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/26/2022] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Minimally invasive total arch replacement (TAR) with frozen elephant trunk (FET) implantation can be carried out through J-, L-, and inverted T-shaped upper ministernotomy. L- and inverted T-shaped upper ministernotomy are selected mostly for their better surgical view compared to J-shaped. However, few studies have paid attention to the difference in clinical effects between J- and L-shaped upper hemisternotomy in acute Type A aortic dissection (ATAAD). MATERIALS AND METHODS We retrospectively analyzed 74 consecutive patients with ATAAD who underwent TAR with FET implantation between December 2019 and October 2020. Patients were divided into the L group (n = 31, L-shaped upper hemisternotomy) and the J group (n = 43, J-shaped upper hemisternotomy). Perioperative characteristics were recorded. RESULTS No significant difference was found in any of the pre-operative, post-operative, or follow-up variables between the two groups. However, the CPB establishment time in the J group was significantly shorter than that in the L group (65.0 ± 17.9 min vs. 77.9 ± 17.2 min, P < 0.05). Other intraoperative variables showed no significant difference. CONCLUSION Total arch replacement with frozen elephant trunk implantation is feasible and can be carried out safely through J-shaped or L-shaped incision. A J-shaped incision might be beneficial for single incision, while an L-shaped incision might be beneficial if an extra incision is required to achieve better artery perfusion.
Collapse
Affiliation(s)
| | | | - Yu Liu
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | | | | |
Collapse
|
33
|
Réhabilitation améliorée après chirurgie cardiaque adulte sous CEC ou à cœur battant 2021. ANESTHÉSIE & RÉANIMATION 2022. [DOI: 10.1016/j.anrea.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
34
|
Liu R, Song J, Chu J, Hu S, Wang XQ. Comparing mini-sternotomy to full median sternotomy for aortic valve replacement with propensity-matching methods. Front Surg 2022; 9:972264. [PMID: 36299570 PMCID: PMC9591805 DOI: 10.3389/fsurg.2022.972264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to compare clinical outcomes between mini-sternotomy and full median sternotomy for aortic valve replacement using propensity-matching methods. Methods From August 2014 to July 2021, a total of 1,445 patients underwent isolated aortic valve surgery, 1,247 via full median sternotomy and 198 via mini-sternotomy. To reduce the impact of potential confounding factors, a propensity score based on 18 variables is used to obtain 198 well-matched case pairs, which include 231 aortic valve regurgitations and 165 aortic stenosis cases. Result Occurrences of in-hospital mortality (P = 0.499), stroke (P > 0.999), renal failure (P = 0.760), and paravalvular leakage (P = 0.224) are similar between the two groups. No significant difference in operation, cardiopulmonary bypass, and aortic cross-clamp times are found between the two groups. However, compared with the full sternotomy group, the mini-sternotomy group has less postoperative 24-hour drainage (131.7 ± 82.8 ml, P < 0.001) and total drainage (459.3 ± 306.3 ml, P < 0.001). The median mechanical ventilation times are 9.4 [interquartile range (IQR) 5.4-15.6] and 9.8 (IQR 6.1-14.4) in mini-sternotomy and full sternotomy groups (P = 0.284), respectively. There are no significant differences in intensive care unit stay and postoperative stay between the two groups. For either aortic valve regurgitations or aortic stenosis patients, significantly less postoperative 24-h and total drainage are still found in the mini-sternotomy group compared with the full sternotomy group. Conclusions Mini-sternotomy for aortic valve replacement is a safe procedure, with not only cosmetic advantages but less postoperative drainage compared with full sternotomy. Mini-sternotomy should be considered for most aortic valve operations.
Collapse
|
35
|
Die superiore Ministernotomie – für welche Operationen? ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-022-00501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
36
|
A Decision-Support Informatics Platform for Minimally Invasive Aortic Valve Replacement. ELECTRONICS 2022. [DOI: 10.3390/electronics11121902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Minimally invasive aortic valve replacement is performed by mini-sternotomy (MS) or less invasive right anterior mini-thoracotomy (RT). The possibility of adopting RT is assessed by anatomical criteria derived from manual 2D image analysis. We developed a semi-automatic tool (RT-PLAN) to assess the criteria of RT, extract other parameters of surgical interest and generate a view of the anatomical region in a 3D space. Twenty-five 3D CT images from a dataset were retrospectively evaluated. The methodology starts with segmentation to reconstruct 3D surface models of the aorta and anterior rib cage. Secondly, the RT criteria and geometric information from these models are automatically and quantitatively evaluated. A comparison is made between the values of the parameters measured by the standard manual 2D procedure and our tool. The RT-PLAN procedure was feasible in all cases. Strong agreement was found between RT-PLAN and the standard manual 2D procedure. There was no difference between the RT-PLAN and the standard procedure when selecting patients for the RT technique. The tool developed is able to effectively perform the assessment of the RT criteria, with the addition of a realistic visualisation of the surgical field through virtual reality technology.
Collapse
|
37
|
Mertes PM, Kindo M, Amour J, Baufreton C, Camilleri L, Caus T, Chatel D, Cholley B, Curtil A, Grimaud JP, Houel R, Kattou F, Fellahi JL, Guidon C, Guinot PG, Lebreton G, Marguerite S, Ouattara A, Provenchère Fruithiot S, Rozec B, Verhoye JP, Vincentelli A, Charbonneau H. Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump. Anaesth Crit Care Pain Med 2022; 41:101059. [PMID: 35504126 DOI: 10.1016/j.accpm.2022.101059] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To provide recommendations for enhanced recovery after cardiac surgery (ERACS) based on a multimodal perioperative medicine approach in adult cardiac surgery patients with the aim of improving patient satisfaction, reducing postoperative mortality and morbidity, and reducing the length of hospital stay. DESIGN A consensus committee of 20 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société française d'anesthésie et de réanimation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Société française de chirurgie thoracique et cardio-vasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guideline process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence. METHODS Six fields were defined: (1) selection of the patient pathway and its information; (2) preoperative management and rehabilitation; (3) anaesthesia and analgesia for cardiac surgery; (4) surgical strategy for cardiac surgery and bypass management; (5) patient blood management; and (6) postoperative enhanced recovery. For each field, the objective of the recommendations was to answer questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). Based on these questions, an extensive bibliographic search was carried out and analyses were performed using the GRADE approach. The recommendations were formulated according to the GRADE methodology and then voted on by all the experts according to the GRADE grid method. RESULTS The SFAR/SFCTCV guideline panel provided 33 recommendations on the management of patients undergoing cardiac surgery under cardiopulmonary bypass or off-pump. After three rounds of voting and several amendments, a strong agreement was reached for the 33 recommendations. Of these recommendations, 10 have a high level of evidence (7 GRADE 1+ and 3 GRADE 1-); 19 have a moderate level of evidence (15 GRADE 2+ and 4 GRADE 2-); and 4 are expert opinions. Finally, no recommendations were provided for 3 questions. CONCLUSIONS Strong agreement existed among the experts to provide recommendations to optimise the complete perioperative management of patients undergoing cardiac surgery.
Collapse
Affiliation(s)
- Paul-Michel Mertes
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Michel Kindo
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Julien Amour
- Institut de Perfusion, de Réanimation, d'Anesthésie de Chirurgie Cardiaque Paris Sud, IPRA, Hôpital Privé Jacques Cartier, Massy, France
| | - Christophe Baufreton
- Department of Cardiovascular and Thoracic Surgery, University Hospital, Angers, France; MITOVASC Institute CNRS UMR 6214, INSERM U1083, University, Angers, France
| | - Lionel Camilleri
- Department of Cardiovascular Surgery, CHU Clermont-Ferrand, T.G.I, I.P., CNRS, SIGMA, UCA, UMR 6602, Clermont-Ferrand, France
| | - Thierry Caus
- Department of Cardiac Surgery, UPJV, Amiens University Hospital, Amiens Picardy University Hospital, Amiens, France
| | - Didier Chatel
- Department of Cardiac Surgery (D.C.), Institut du Coeur Saint-Gatien, Nouvelle Clinique Tours Plus, Tours, France
| | - Bernard Cholley
- Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges-Pompidou, AP-HP, Université de Paris, INSERM, IThEM, Paris, France
| | - Alain Curtil
- Department of Cardiac Surgery, Clinique de la Sauvegarde, Lyon, France
| | | | - Rémi Houel
- Department of Cardiac Surgery, Saint Joseph Hospital, Marseille, France
| | - Fehmi Kattou
- Department of Anaesthesia and Intensive Care, Institut Mutualiste Montsouris, Paris, France
| | - Jean-Luc Fellahi
- Service d'Anesthésie-Réanimation, Hôpital Universitaire Louis Pradel, Hospices Civils de Lyon, Lyon, France; Faculté de Médecine Lyon Est, Université Claude-Bernard Lyon 1, Lyon, France
| | - Catherine Guidon
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Aix Marseille University, Marseille, France
| | - Pierre-Grégoire Guinot
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France; University of Bourgogne and Franche-Comté, LNC UMR1231, Dijon, France; INSERM, LNC UMR1231, Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - Guillaume Lebreton
- Sorbonne Université, INSERM, Unité mixte de recherche CardioMetabolisme et Nutrition, ICAN, AP-HP, Hôpital Pitié-Salpétrière, Paris, France
| | - Sandrine Marguerite
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Alexandre Ouattara
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, F-33600 Pessac, France
| | - Sophie Provenchère Fruithiot
- Department of Anaesthesia, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France; Centre d'Investigation Clinique 1425, INSERM, Université de Paris, Paris, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, Hôpital Laennec, CHU Nantes, Nantes, France; Université de Nantes, CHU Nantes, CNRS, INSERM, Institut duDu Thorax, Nantes, France
| | - Jean-Philippe Verhoye
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - André Vincentelli
- Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France
| | | |
Collapse
|
38
|
Luo ZR, Chen YX, Chen LW. Surgical outcomes associated with partial upper sternotomy in obese aortic disease patients. J Cardiothorac Surg 2022; 17:135. [PMID: 35641935 PMCID: PMC9158371 DOI: 10.1186/s13019-022-01890-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Excellent partial upper sternotomy outcomes have been reported for patients undergoing aortic surgery, but whether this approach is particularly beneficial to obese patients remains to be established. This study was developed to explore the outcomes of aortic surgical procedures conducted via a partial upper sternotomy or a full median sternotomy approach in obese patients. Methods We retrospectively examined consecutive acute type A aortic dissection patients who underwent aortic surgery in our hospital between January 2015 to January 2021. Patients were divided into two groups based on body mass index: ‘non-obese’ and ‘obese’. We then further stratified patients in the obese and non-obese groups into partial upper sternotomy and full median sternotomy groups, with outcomes between these two sternotomy groups then being compared within and between these two body mass index groups. Results In total, records for 493 patients that had undergone aortic surgery were retrospectively reviewed, leading to the identification of 158 consecutive obese patients and 335 non-obese patients. Overall, 88 and 70 obese patients underwent full median sternotomy and partial upper sternotomy, respectively, while 180 and 155 non-obese patients underwent these respective procedures. There were no differences between the full median sternotomy and partial upper sternotomy groups within either BMI cohort with respect to preoperative baseline indicators and postoperative complications. Among non-obese individuals, the partial upper sternotomy approach was associated with reduced ventilation time (P = 0.003), shorter intensive care unit stay (P = 0.017), shorter duration of hospitalization (P = 0.001), and decreased transfusion requirements (Packed red blood cells: P < 0.001; Fresh frozen plasma: P < 0.001). Comparable findings were also evident among obese patients. Conclusions Obese aortic disease patients exhibited beneficial outcomes similar to those achieved for non-obese patients via a partial upper sternotomy approach which was associated with significant reductions in the duration of intensive care unit residency, duration of hospitalization, ventilator use, and transfusion requirements. This surgical approach should thus be offered to aortic disease patients irrespective of their body mass index.
Collapse
Affiliation(s)
- Zeng-Rong Luo
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Yi-Xing Chen
- Department of Cardiology, Nan Ping First Hospital Affiliated to Fujian Medical University, Nanping, 353000, People's Republic of China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.
| |
Collapse
|
39
|
Agnino A, Graniero A, Gerometta P, Giroletti L, Albano G, Roscitano C, Anselmi A. Less invasive aortic valve replacement using the trifecta bioprosthesis. SCAND CARDIOVASC J 2022; 56:79-84. [PMID: 35536053 DOI: 10.1080/14017431.2022.2071460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives. The safety and effectiveness of the Trifecta GT bioprosthesis (introduced in 2016) in less invasive aortic valve replacement are scarcely investigated. Our aim was to evaluate the immediate and initial follow-up results of this device in the context of less invasive surgery. We discuss patient-specific strategies for the selection of the surgical approach. Methods. A retrospective review of 133 patients undergoing AVR with the Trifecta GT through three less invasive accesses (UMS, Upper ministernotomy; RMS, Reversed ministernotomy; RAMT, Right anterior minithoracotomy) was performed. In-hospital, follow-up and hemodynamic performance (PPM, Patient-prosthesis mismatch) data were collected. Results. Among patients, 79% received UMS, 11% RMS and 10% RAMT. Selection of approach was based on preoperative anatomical analysis (CT-scan) and planned concomitant procedures. There was no operative mortality, no valve-related adverse events. There were 36 concomitant procedures. No significant intergroup differences occurred in cardiopulmonary bypass, aortic clamp, mechanical ventilation time, ICU stay and average bleeding. There were two cases of moderate PPM (1.5%) and no instances of severe PPM; there were no significant (≥2/4) perivalvular leaks. Average mean gradient at discharge was 8 ± 3 mmHg. At follow-up (average: 2.5 ± 0.9 years, 100% complete, 315 patient years) there was no mortality and no valve-related adverse event. Hemodynamic performance was maintained at follow-up. Conclusions. The optimal device for less invasive AVR needs to be individualized, as well as the selection of the surgical approach. The use of the Trifecta GT bioprosthesis appears to be reproductible whatever less invasive approach is employed, with confirmed excellent hemodynamic performance.
Collapse
Affiliation(s)
- Alfonso Agnino
- Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.,Division of Robotic and Minimally Invasive Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Ascanio Graniero
- Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.,Division of Robotic and Minimally Invasive Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | | | - Laura Giroletti
- Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.,Division of Robotic and Minimally Invasive Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Giovanni Albano
- Division of Cardiac Anesthesia, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Claudio Roscitano
- Division of Cardiac Anesthesia, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| |
Collapse
|
40
|
Ríos-Ortega JC, Sisniegas-Razón J, Conde-Moncada R, Pérez-Valverde Y, Morón-Castro J. Aortic valve replacement through minithoracotomy. Results from the Peruvian experience. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:69-73. [PMID: 37283599 PMCID: PMC10241336 DOI: 10.47487/apcyccv.v3i2.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/30/2022] [Indexed: 06/08/2023]
Abstract
Objectives To assess mortality, major valve-related events (MAVRE), and other complications in the perioperative period and follow up in patients with aortic valve replacement (AVR) through mini-thoracotomy (MT). Methods We retrospectively analyzed patients aged <80 who underwent AVR through MT between January 2017 and December 2021 in a national reference center in Lima, Peru. Patients undergoing other surgical approaches (mini-sternotomy, etc.), other concomitant cardiac procedures, redo, and emergency surgeries were excluded. We measured the variables (MAVRE, mortality, and other clinical variables) at 30 days and a mean follow-up of 12 months. Results Fifty-four patients were studied, the median age was 69.5 years, and 65% were women. Aortic valve (AV) stenosis was the main indication for surgery (65%), and bicuspid AV represented 55.6% of cases. At 30-days, MAVRE occurred in two patients (3.7%), with no in-hospital mortality. One patient had an intraoperative ischemic stroke, and one required a permanent pacemaker. No patient underwent reoperation due to prosthesis dysfunction or endocarditis. In a mean follow-up of one year, MAVRE occurrence did not show variations with the perioperative period, most patients remained in NYHA I (90.7%) or II (7.4%) compared to the preoperative period (p<0.001). Conclusions AV replacement through MT is a safe procedure in our center for patients under 80 years.
Collapse
Affiliation(s)
- Josías C Ríos-Ortega
- Departamento de Cirugía Cardiovascular, Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú. Departamento de Cirugía Cardiovascular Instituto Nacional Cardiovascular INCOR- EsSalud Lima Perú
| | - Josué Sisniegas-Razón
- Departamento de Cirugía Cardiovascular, Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú. Departamento de Cirugía Cardiovascular Instituto Nacional Cardiovascular INCOR- EsSalud Lima Perú
| | - Roger Conde-Moncada
- Departamento de Cirugía Cardiovascular, Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú. Departamento de Cirugía Cardiovascular Instituto Nacional Cardiovascular INCOR- EsSalud Lima Perú
| | - Yemmy Pérez-Valverde
- Departamento de Cirugía Cardiovascular, Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú. Departamento de Cirugía Cardiovascular Instituto Nacional Cardiovascular INCOR- EsSalud Lima Perú
| | - Julio Morón-Castro
- Departamento de Cirugía Cardiovascular, Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú. Departamento de Cirugía Cardiovascular Instituto Nacional Cardiovascular INCOR- EsSalud Lima Perú
| |
Collapse
|
41
|
Sef D, Bahrami T, Raja SG, Klokocovnik T. Current trends in minimally invasive valve‐sparing aortic root replacement—Best available evidence. J Card Surg 2022; 37:1684-1690. [PMID: 35348237 DOI: 10.1111/jocs.16453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/20/2022] [Accepted: 03/05/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield Hospitals Part of Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Toufan Bahrami
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield Hospitals Part of Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Shahzad G. Raja
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield Hospitals Part of Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Tomislav Klokocovnik
- Department of Cardiovascular Surgery University Hospital Center Ljubljana Ljubljana Slovenia
| |
Collapse
|
42
|
Wilson TW, Horns JJ, Sharma V, Goodwin ML, Kagawa H, Pereira SJ, McKellar SH, Selzman CH, Glotzbach JP. Minimally Invasive versus Full Sternotomy SAVR in the Era of TAVR: An Institutional Review. J Clin Med 2022; 11:jcm11030547. [PMID: 35159998 PMCID: PMC8836475 DOI: 10.3390/jcm11030547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/04/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023] Open
Abstract
In the era of advancing transcatheter aortic valve replacement (TAVR) technology, traditional open surgery remains a valuable intervention for patients who are not TAVR candidates. We sought to compare perioperative variables and postoperative outcomes of minimally invasive and full sternotomy surgical aortic valve replacement (SAVR) at a single institution. A retrospective analysis of 113 patients who underwent isolated SAVR via full sternotomy or upper hemi-sternotomy between January 2015 and December 2019 at the University of Utah Hospital was performed. Preoperative comorbidities and demographic information were not different among groups, with the exception of diabetes, which was significantly more common in the full sternotomy group (p = 0.01). Median procedure length was numerically shorter in the minimally invasive group but was not significant following the Bonferroni correction (p = 0.047). Other perioperative variables were not significantly different. The two groups showed no difference in the incidence of postoperative adverse events (p = 0.879). As such, minimally invasive SAVR via hemi-sternotomy remains a safe and effective alternative to full sternotomy for patients who meet the criteria for aortic valve replacement.
Collapse
Affiliation(s)
- Tyler W. Wilson
- School of Medicine, University of Utah, Salt Lake City, UT 84132, USA;
| | - Joshua J. Horns
- Department of Surgery, University of Utah, Salt Lake City, UT 84132, USA;
| | - Vikas Sharma
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT 84132, USA; (V.S.); (M.L.G.); (H.K.); (S.J.P.); (C.H.S.)
| | - Matthew L. Goodwin
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT 84132, USA; (V.S.); (M.L.G.); (H.K.); (S.J.P.); (C.H.S.)
| | - Hiroshi Kagawa
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT 84132, USA; (V.S.); (M.L.G.); (H.K.); (S.J.P.); (C.H.S.)
| | - Sara J. Pereira
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT 84132, USA; (V.S.); (M.L.G.); (H.K.); (S.J.P.); (C.H.S.)
| | - Stephen H. McKellar
- Cardiovascular and Thoracic Surgery, Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA;
| | - Craig H. Selzman
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT 84132, USA; (V.S.); (M.L.G.); (H.K.); (S.J.P.); (C.H.S.)
| | - Jason P. Glotzbach
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT 84132, USA; (V.S.); (M.L.G.); (H.K.); (S.J.P.); (C.H.S.)
- Correspondence:
| |
Collapse
|
43
|
Almeida AS, Ceron RO, Anschau F, de Oliveira JB, Leão Neto TC, Rode J, Rey RAW, Lira KB, Delvaux RS, de Souza RORR. Conventional Versus Minimally Invasive Aortic Valve Replacement Surgery: A Systematic Review, Meta-Analysis, and Meta-Regression. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:3-13. [PMID: 35044253 DOI: 10.1177/15569845211060039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: To assess the potential benefits of minimally invasive aortic valve replacement (MIAVR) compared with conventional AVR (CAVR) by examining short-term outcomes. Methods: A systematic search identified randomized trials comparing MIAVR with CAVR. To assess study limitations and quality of evidence, we used the Cochrane Risk of Bias tool and GRADE and performed random-effects meta-analysis. We used meta-regression and sensitivity analysis to explore reasons for diversity. Results: Thirteen studies (1,303 patients) were included. For the comparison of MIAVR and CAVR, the risk of bias was judged low or unclear and the quality of evidence ranged from very low to moderate. No significant difference was observed in mortality, stroke, acute kidney failure, infectious outcomes, cardiac events, intubation time, intensive care unit stay, reoperation for bleeding, and blood transfusions. Blood loss (mean difference [MD] = -130.58 mL, 95% confidence interval [CI] = -216.34 to -44.82, I2 = 89%) and hospital stay (MD = -0.93 days, 95% CI = -1.62 to -0.23, I2 = 81%) were lower with MIAVR. There were shorter aortic cross-clamp (MD = 5.99 min, 95% CI = 0.99 to 10.98, I2 = 93%) and cardiopulmonary bypass (CPB) times (MD = 7.75 min, 95% CI = 0.27 to 15.24, I2 = 94%) in the CAVR group. In meta-regression analysis, we found that age was the variable with the greatest influence on heterogeneity. Conclusions: MIAVR seems to be an excellent alternative to CAVR, reducing hospital stay and incidence of hemorrhagic events. Despite significantly greater aortic cross-clamp and CPB times with MIAVR, this did not translate into adverse effects, with no changes in the results found with CAVR.
Collapse
Affiliation(s)
- Adriana Silveira Almeida
- Postgraduate Studies Program in Minimally Invasive Cardiovascular Surgery, Goiânia, Brazil.,Cardiothoracic Surgery Division, 125208Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, Brazil.,Health Technology Assessment Center (NATS), 581607Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Rafael Oliveira Ceron
- Cardiothoracic Surgery Division, 125208Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Fernando Anschau
- Cardiothoracic Surgery Division, 125208Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, Brazil.,Health Technology Assessment Center (NATS), 581607Grupo Hospitalar Conceição, Porto Alegre, Brazil.,Postgraduate Program in Technology Assessment for SUS (PPGATSUS/GHC), 581607Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Jeffchandler Belém de Oliveira
- Postgraduate Studies Program in Minimally Invasive Cardiovascular Surgery, Goiânia, Brazil.,Cardiothoracic Surgery Division, Hospital Ruy Azeredo, Goiânia, Brazil
| | - Tércio Campos Leão Neto
- Postgraduate Studies Program in Minimally Invasive Cardiovascular Surgery, Goiânia, Brazil.,Cardiothoracic Surgery Division, Hospital Ruy Azeredo, Goiânia, Brazil
| | - Juarez Rode
- Cardiothoracic Surgery Division, 125208Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Rafael Antonio Widholzer Rey
- Cardiothoracic Surgery Division, 125208Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Kathize Betti Lira
- Cardiothoracic Surgery Division, 125208Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Renan Senandes Delvaux
- Cardiothoracic Surgery Division, 125208Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Rodrigo Oliveira Rosa Ribeiro de Souza
- Postgraduate Studies Program in Minimally Invasive Cardiovascular Surgery, Goiânia, Brazil.,Cardiothoracic Surgery Division, Hospital Ruy Azeredo, Goiânia, Brazil
| |
Collapse
|
44
|
Salmasi MY, Papa K, Mozalbat D, Ashraf M, Zientara A, Chauhan I, Karadatkou N, Athanasiou T, Roussin I, Quarto C, Asimakopoulos G. Converging rapid deployment prostheses with minimal access surgery: analysis of early outcomes. J Cardiothorac Surg 2021; 16:355. [PMID: 34961528 PMCID: PMC8714419 DOI: 10.1186/s13019-021-01739-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Sutureless prostheses may have added benefit when combined with minimal access surgery, although this has not been fully assessed in the literature. This study aims to provide a comparative analysis of the Perceval valve comparing median sternotomy (MS) with mini-sternotomy (MIS). Methods A retrospective analysis of prospectively collected data was conducted for all isolated aortic valve replacement (AVR), using the Perceval valve, for severe aortic stenosis cases in the period 2014 to 2019. Patients undergoing concomitant valve or revascularisation surgery were excluded. Results A total of 78 patients were included: MS group 41; MIS group 37. Operatively, bypass times were comparable between MS and MIS groups (mean 89.3 vs 83.4, p = 0.307), as were aortic cross clamp times (58.4 vs 55.9, p = 0.434). There were no operative deaths or new onset post-operative neurology. MIS was a predictor of reduced stay in the intensive care unit (coef − 3.25, 95% CI [− 4.93, − 0.59], p = 0.036) and hospital stay overall (p = 0.004). Blood transfusion units were comparable as were the incidence of heart block (n = 5 vs n = 3, p = 0.429) and new onset atrial fibrillation (n = 15 vs n = 9, p = 0.250). Follow-up echocardiography found a significant improvement in effective orifice area, left ventricular dimension and volume indices, and LVEF (p > 0.05) for all patients. Multivariate analysis found mini-sternotomy to be a predictor for reduced LV diastolic volume (coef − 0.35, 95% CI [− 1.02, − 0.05], p = 0.05). Conclusions The combination of minimal access surgery and sutureless AVR may enhance patient recovery and provide early LV remodelling.
Collapse
Affiliation(s)
- M Yousuf Salmasi
- Department of Surgery, Imperial College London, 10th Floor QEQM, Praed Street, London, W2 1NY, UK. .,Royal Brompton and Harefield Foundation Trust, London, UK.
| | - Kristo Papa
- Royal Brompton and Harefield Foundation Trust, London, UK
| | - David Mozalbat
- Royal Brompton and Harefield Foundation Trust, London, UK
| | | | | | - Ishaan Chauhan
- Royal Brompton and Harefield Foundation Trust, London, UK
| | | | - Thanos Athanasiou
- Department of Surgery, Imperial College London, 10th Floor QEQM, Praed Street, London, W2 1NY, UK
| | | | - Cesare Quarto
- Royal Brompton and Harefield Foundation Trust, London, UK
| | | |
Collapse
|
45
|
Zallé I, Son M, El-Alaoui M, Nijimbéré M, Boumzebra D. Minimally invasive and full sternotomy in aortic valve replacement: a comparative early operative outcomes. Pan Afr Med J 2021; 40:68. [PMID: 34804336 PMCID: PMC8590260 DOI: 10.11604/pamj.2021.40.68.28008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 09/20/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction aortic valve replacement is usually performed through a median full sternotomy (MFS) in our department. Minimally invasive aortic valve replacement (MIAVR) has been recently adopted as a new approach. According to the literature, the superiority of MIAVR is controversial. In this study we report early post-operative outcomes in MIAVR compared with MFS access with reference to blood Loss, wound infections, post-operative recovery, morbidity and mortality. Methods this study was a prospective data collection from 36 consecutive patients undergoing isolated valve replacement. Two population study was identified, MIAVR group (group I n=18) and MFS group (group II n=18). Patients´ data were collected and analyzed using IBM SPSS statistics 21 software and Khi2 test has been used to compare the variables. The study variables are presented as numbers, percentage, median with interquartile range. Pre-operative planning was performed so that to obtain similar characteristics. Results in group I, upper mini-sternotomy was used in 12 patients and right mini-thoracotomy in 6 patients. There was no difference in term of mortality and morbidity. MIAVR was associated with longer CPB time (93.25 (58-161) vs 131 (75-215) mins, P=0.047) with no significant difference in term of ACC time (81 (33-162) vs 58.8 (59-102) mins P=0.158). MIAVR´ Patients had likely lower incidence of red blood cells transfusion (16.7 vs 52.3%) without significant difference about post-operative haemoglobin (P = 0,330). Patients in group I had shorter ventilation time (2.35 (1-12) vs 9.3 (1-48) hours P < 0.01), shorter ICU stay (2.44 (1-8) vs 4.25 (1-9) days, P = 0,024). The length of hospital stay was shorter, 6.5 (5-9) days in group I vs 7.4 (6-11), P=0.0274. Length of chest tube stay was shorter in group I (mean 1.53 vs 2.4 days, P=0,033). Wound infections were not found in both groups. Conclusion minimally invasive aortic valve replacement is associated with less blood loss, faster post-operative recovery faster post-operative recovery but increase operation time.
Collapse
Affiliation(s)
- Issaka Zallé
- Cardiovascular Surgery Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Moussa Son
- Cardiovascular Surgery Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Mohamed El-Alaoui
- Cardiovascular Surgery Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Macédoine Nijimbéré
- Cardiovascular Surgery Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Drissi Boumzebra
- Cardiovascular Surgery Department, Mohammed VI University Hospital, Marrakech, Morocco
| |
Collapse
|
46
|
Reemplazo valvular aórtico a través de esternotomía parcial superior vs. esternotomía convencional media: análisis mediante índice de propensión. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
47
|
Olsthoorn JR, Daemen JHT, de Loos ER, Ter Woorst JF, van Straten AHM, Maessen JG, Sardari Nia P, Heuts S. Right Anterolateral Thoracotomy Versus Sternotomy for Resection of Benign Atrial Masses: A Systematic Review and Meta-Analysis. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:426-433. [PMID: 34338071 DOI: 10.1177/15569845211032230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Primary benign cardiac tumors are rare disease entity that predominantly originate from the atria. Benign masses can induce heart failure, arrhythmia, or thromboembolic events. Therefore, surgical excision is often indicated. Current guidelines on the preferred approaches for resection (i.e., median sternotomy [MST] or right anterolateral thoracotomy [RAT]) are lacking. The aim of the current meta-analysis was to evaluate all studies comparing RAT to MST for excision of benign atrial masses in terms of safety, efficacy, and complications. METHODS The PubMed and EMBASE databases were searched through 9 June 2020. Data regarding mortality, complications, recurrence, ICU stay, and length of hospital stay were extracted and submitted to meta-analysis using random effects modelling. Heterogeneity was assessed by the I 2 test. RESULTS Four retrospective observational studies were included, including 196 patients (RAT n = 97, MST n = 99). Mortality was 0% in both groups. Recurrence was <1% in the RAT group and 0% in the MST group. Complication rate tended to be lower in favor of the RAT group. Furthermore, RAT was associated with lower length of ICU stay (-17.7 hr, P = 0.01) and hospital stay (-4.0 days, P < 0.001). No significant differences in cardiopulmonary bypass (P = 0.09) and cross-clamp times (P = 0.15) were observed. CONCLUSIONS The RAT approach is as safe and effective as MST for the excision of benign atrial masses. Moreover, RAT is associated with a reduced complication rate and a reduced duration of hospitalization and could be considered as the preferred approach in anatomically suitable patients.
Collapse
Affiliation(s)
- Jules R Olsthoorn
- 3168 Department of Cardiothoracic Surgery, Catharina Ziekenhuis Eindhoven, The Netherlands
| | - Jean H T Daemen
- 3802 Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik R de Loos
- 3802 Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Joost F Ter Woorst
- 3168 Department of Cardiothoracic Surgery, Catharina Ziekenhuis Eindhoven, The Netherlands
| | - Albert H M van Straten
- 3168 Department of Cardiothoracic Surgery, Catharina Ziekenhuis Eindhoven, The Netherlands
| | - Jos G Maessen
- 118066199236 Department of Cardiothoracic Surgery, Maastricht University Medical Center, The Netherlands
| | - Peyman Sardari Nia
- 118066199236 Department of Cardiothoracic Surgery, Maastricht University Medical Center, The Netherlands
| | - Samuel Heuts
- 118066199236 Department of Cardiothoracic Surgery, Maastricht University Medical Center, The Netherlands
| |
Collapse
|
48
|
Torky MA, Arafat AA, Fawzy HF, Taha AM, Wahby EA, Herijgers P. J-ministernotomy for aortic valve replacement: a retrospective cohort study. THE CARDIOTHORACIC SURGEON 2021. [DOI: 10.1186/s43057-021-00050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The advantage of minimally invasive sternotomy (MS) over full sternotomy (FS) for isolated aortic valve replacement (AVR) is still controversial. We aimed to examine if J-shaped MS is a safe alternative to FS in patients undergoing primary isolated AVR. This study is a retrospective and restricted cohort study that included 137 patients who had primary isolated AVR from February 2013 to June 2015. Patients with previous cardiac operations, low ejection fraction (< 40%), infective endocarditis, EuroSCORE II predicted mortality > 10%, and patients who had inverted T or inverted C-MS or right anterior thoracotomy were excluded. Patients were grouped into the FS group (n=65) and MS group (n=72). Preoperative variables were comparable in both groups. The outcome was studied, balancing the groups by propensity score matching.
Results
Seven (9%) patients in the MS group were converted to FS. Cardiopulmonary bypass (98.5 ± 29.3 vs. 82.1 ± 13.95 min; p ≤ 0.001) and ischemic times (69.1 ± 23.8 vs. 59.6 ± 12.2 min; p = 0.001) were longer in MS. The MS group had a shorter duration of mechanical ventilation (10.1 ± 11.58 vs. 10.9 ± 6.43 h; p = 0.045), ICU stay (42.74 ± 40.5 vs. 44.9 ± 39.3; p = 0.01), less chest tube drainage (385.3 ± 248.6 vs. 635.9 ± 409.6 ml; p = 0.001), and lower narcotics use (25.14 ± 17.84 vs. 48.23 ± 125.68 mg; p < 0.001). No difference was found in postoperative heart block with permanent pacemaker insertion or atrial fibrillation between groups (p = 0.16 and 0.226, respectively). Stroke, renal failure, and mortality did not differ between the groups. Reintervention-free survival at 1, 3, and 4 years was not significantly different in both groups (p = 0.73).
Conclusion
J-ministernotomy could be a safe alternative to FS in isolated primary AVR. Besides the cosmetic advantage, it could have better clinical outcomes without added risk.
Collapse
|
49
|
Rayner TA, Harrison S, Rival P, Mahoney DE, Caputo M, Angelini GD, Savović J, Vohra HA. Minimally invasive versus conventional surgery of the ascending aorta and root: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2021; 57:8-17. [PMID: 31209468 DOI: 10.1093/ejcts/ezz177] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 01/28/2023] Open
Abstract
Limited uptake of minimally invasive surgery (MIS) of the aorta hinders assessment of its efficacy compared to median sternotomy (MS). The objective of this systematic review is to compare operative and perioperative outcomes for MIS versus MS. Online databases Medline, EMBASE, Cochrane Library and Web of Science were searched from inception until July 2018. Both randomized and observational studies of patients undergoing aortic root, ascending aorta or aortic arch surgery by MIS versus MS were eligible for inclusion. Primary outcomes were 30-day mortality, reoperation for bleeding, perioperative renal impairment and neurological events. Intraoperative and postoperative timing measures were also evaluated. Thirteen observational studies were included comparing 1101 MIS and 1405 MS patients. The overall quality of evidence was very low for all outcomes. Mortality and the incidence of stroke were similar between the 2 cohorts. Meta-analysis demonstrated increased length of cardiopulmonary bypass (CPB) time for patients undergoing MS [standardized mean difference 0.36, 95% confidence interval (CI) 0.15-0.58; P = 0.001]. Patients receiving MS spent more time in hospital (standardized mean difference 0.30, 95% CI 0.17-0.43; P < 0.001) and intensive care (standardized mean difference 0.17, 95% CI 0.06-0.27; P < 0.001). Reoperation for bleeding (risk ratio 1.51, 95% CI 1.06-2.17; P = 0.024) and renal impairment (risk ratio 1.97, 95% CI 1.12-3.46; P = 0.019) were also greater for MS patients. There was substantial heterogeneity in meta-analyses for CPB and aortic cross-clamp timing outcomes. MIS may be associated with improved early clinical outcomes compared to MS, but the quality of the evidence is very low. Randomized evidence is needed to confirm these findings.
Collapse
Affiliation(s)
- Tom A Rayner
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Sean Harrison
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Rival
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Massimo Caputo
- Department of Cardiac Surgery, Bristol Hearth Institute, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiac Surgery, Bristol Hearth Institute, Bristol, UK
| | - Jelena Savović
- Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiac Surgery, Bristol Hearth Institute, Bristol, UK
| |
Collapse
|
50
|
Andreas M, Berretta P, Solinas M, Santarpino G, Kappert U, Fiore A, Glauber M, Misfeld M, Savini C, Mikus E, Villa E, Phan K, Fischlein T, Meuris B, Martinelli G, Teoh K, Mignosa C, Shrestha M, Carrel TP, Yan T, Laufer G, Di Eusanio M. Minimally invasive access type related to outcomes of sutureless and rapid deployment valves. Eur J Cardiothorac Surg 2021; 58:1063-1071. [PMID: 32588056 PMCID: PMC7577292 DOI: 10.1093/ejcts/ezaa154] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Minimally invasive surgical techniques with optimal outcomes are of paramount importance. Sutureless and rapid deployment aortic valves are increasingly implanted via minimally invasive approaches. We aimed to analyse the procedural outcomes of a full sternotomy (FS) compared with those of minimally invasive cardiac surgery (MICS) and further assess MICS, namely ministernotomy (MS) and anterior right thoracotomy (ART). METHODS We selected all isolated aortic valve replacements in the Sutureless and Rapid Deployment Aortic Valve Replacement International Registry (SURD-IR, n = 2257) and performed propensity score matching to compare aortic valve replacement through FS or MICS (n = 508/group) as well as through MS and ART accesses (n = 569/group). RESULTS Postoperative mortality was 1.6% in FS and MICS patients who had a mean logistic EuroSCORE of 11%. Cross-clamp and cardiopulmonary bypass (CPB) times were shorter in the FS group than in the MICS group (mean difference 3.2 and 9.2 min; P < 0.001). Patients undergoing FS had a higher rate of acute kidney injury (5.6% vs 2.8%; P = 0.012). Direct comparison of MS and ART revealed longer mean cross-clamp and CPB times (12 and 16.7 min) in the ART group (P < 0.001). The postoperative outcome revealed a higher stroke rate (3.2% vs 1.2%; P = 0.043) as well as a longer postoperative intensive care unit [2 (1-3) vs 1 (1-3) days; P = 0.009] and hospital stay [11 (8-16) vs 8 (7-12) days; P < 0.001] in the MS group than in the ART group. CONCLUSIONS According to this non-randomized international registry, FS resulted in a higher rate of acute kidney injury. The ART access showed a lower stroke rate than MS and a shorter hospital stay than all other accesses. All these findings may be related to underlying patient risk factors.
Collapse
Affiliation(s)
- Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy
| | | | - Giuseppe Santarpino
- Città di Lecce Hospital, GVM Care & Research, Cotignola, Italy.,Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Centre Dresden, Dresden, Germany
| | - Antonio Fiore
- Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Mattia Glauber
- Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy
| | - Martin Misfeld
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | - Carlo Savini
- Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elisa Mikus
- Cardiovascular Surgery Unit, Maria Cecilia Hospital GVM Care & Research, Cotignola, Italy
| | - Emmanuel Villa
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Kevin Phan
- The Collaborative Research (CORE) Group, Sydney, Australia
| | - Theodor Fischlein
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Bart Meuris
- Cardiac Surgery, Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium
| | | | - Kevin Teoh
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Carmelo Mignosa
- Department for the Treatment and Study of Cardiothoracic Diseases, Cardiothoracic Transplantation IRCCS-ISMETT, Palermo, Italy
| | - Malakh Shrestha
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thierry P Carrel
- Department of Cardiovascular Surgery, University Hospital, University of Bern, Bern, Switzerland
| | - Tristan Yan
- Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia.,The Collaborative Research (CORE) Group, Sydney, Australia
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy.,The Collaborative Research (CORE) Group, Sydney, Australia
| |
Collapse
|