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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.
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García N, Bermúdez A, Martín MÁ, Carmona C, Jaén C, Daroca T. Resultados de la cirugía de mínimo acceso sobre la válvula aórtica en nuestro centro. CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Cánovas López SJ, Estevez Cid F, Reyes Copa G, López Gude MJ, Melero Tejedor JM, Badía Gamarra S. Cirugía cardiaca mediante mínimo acceso. Registro multicéntrico español. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cánovas López SJ, Estevez Cid F, Reyes Copa G, López Gude MJ, Melero Tejedor JM, Badía Gamarra S. Miniaccess Heart Surgery. A Spanish Multicenter Registry. ACTA ACUST UNITED AC 2017; 71:587-588. [PMID: 28601411 DOI: 10.1016/j.rec.2017.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/30/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Sergio Juan Cánovas López
- Servicio de Cirugía Cardiovascular, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB, El Palmar, Murcia, Spain.
| | - Francisco Estevez Cid
- Servicio de Cirugía Cardiaca, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Guillermo Reyes Copa
- Servicio de Cirugía Cardiaca, Hospital Universitario de La Princesa, Madrid, Spain
| | | | | | - Sara Badía Gamarra
- Servicio de Cirugía Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Rodríguez-Caulo EA, Otero J, Mataró MJ, Sánchez-Espín G, Porras C, Guzón A, Such M, Melero JM. Cirugía valvular aórtica mínimamente invasiva. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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6
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Mejora de la morbilidad postoperatoria en recambio valvular aórtico aislado con miniesternotomía: estudio pareado por puntuación de propensión. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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7
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Implante de válvula aórtica transcatéter. Una revisión de las vías de abordaje. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Acharya M, Harling L, Moscarelli M, Ashrafian H, Athanasiou T, Casula R. Influence of body mass index on outcomes after minimal-access aortic valve replacement through a J-shaped partial upper sternotomy. J Cardiothorac Surg 2016; 11:74. [PMID: 27118140 PMCID: PMC4847251 DOI: 10.1186/s13019-016-0467-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/17/2016] [Indexed: 12/03/2022] Open
Abstract
Background Minimal-access aortic valve replacement (MAAVR) may reduce post-operative blood loss and transfusion requirements, decrease post-operative pain, shorten length stay and enhance cosmesis. This may be particularly advantageous in overweight/obese patients, who are at increased risk of post-operative complications. Obese patients are however often denied MAAVR due to the perceived technical procedural difficulty. This retrospective analysis sought to determine the effect of BMI on post-operative outcomes in patients undergoing MAAVR. Methods Ninety isolated elective MAAVR procedures performed between May 2006–October 2013 were included. Intra- and post-operative data were prospectively collected. Ordinary least squares univariate linear regression analysis was performed to determine the effect of BMI as a continuous variable on post-operative outcomes. One-way ANOVA and Chi-squared testing was used to assess differences in outcomes between patients with BMI <25 (n = 36) and BMI ≥25 (n = 54) as appropriate. Results There was no peri-operative mortality, myocardial infarction or stroke. Univariate regression demonstrated longer cross-clamp times (p = 0.0218) and a trend towards increased bypass times (p = 0.0615) in patients with higher BMI. BMI ≥25 was associated with an increased incidence of hospital-acquired pneumonia (p = 0.020) and new-onset atrial fibrillation (p = 0.036) compared to BMI <25. However, raised BMI did not extend ICU (p = 0.3310) or overall hospital stay (p = 0.2614). Similar rates of sternal wound complications, inotrope requirements and renal dysfunction were observed in both normal- and overweight/obese-BMI groups. Furthermore, increasing BMI correlated with reduced mechanical ventilation time (p = 0.039) and early post-operative blood loss (p = 0.004). Conclusions Our results demonstrate that within the range of this study, MAAVR is a safe, reproducible and effective procedure, affording equivalent clinical outcomes in both overweight/obese and normal-weight patients considered for an isolated first-time AVR, with low post-operative morbidity and mortality. MAAVR should therefore be considered as an alternative surgical strategy to reduce obesity-related complications in patients requiring aortic valve replacement.
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Affiliation(s)
- Metesh Acharya
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| | - Leanne Harling
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK. .,The Department of Surgery and Cancer, 10th Floor QEQM Building, St Mary's Hospital, Praed St., London, W2 1NY, UK.
| | - Marco Moscarelli
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| | - Hutan Ashrafian
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| | - Roberto Casula
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
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Experiencia inicial con la prótesis de despliegue rápido en posición aórtica Edwards Intuity. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2015.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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O'Sullivan KE, Bargenda S, Sugrue D, Hurley J. Advances in the management of severe aortic stenosis. Ir J Med Sci 2016; 185:309-17. [PMID: 26886020 DOI: 10.1007/s11845-016-1417-7] [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: 02/06/2015] [Accepted: 11/16/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent developments in the management of severe aortic stenosis have resulted in a paradigm shift in the way we view the condition. Patients previously denied intervention in the form of surgical aortic valve replacement (SAVR) are now candidates for transcatheter aortic valve implantation and the risk and age profiles of those undergoing SAVR are rising with the ageing population. This review article is designed to provide an overview of developments in the surgical management of severe aortic stenosis. We also discuss the expanding role of minimally invasive surgical approaches to outline the current techniques available to treat patients with severe aortic stenosis. METHODS PubMed was searched using the terms 'severe aortic stenosis', 'surgical aortic valve replacement', 'transcatheter aortic valve replacement', 'mechanical aortic valve replacement' and 'sutureless aortic valve replacement'. Selection of articles was based on peer review, journal and relevance. Where possible articles from high-impact factor peer review journals were included. RESULTS Minimally invasive operative approaches include mini-sternotomy and mini-thoracotomy. Sutureless aortic prostheses reduce aortic cross-clamp time and cardiopulmonary bypass time; however, long-term follow-up data are unavailable at this time. Mechanical prostheses are advised for those under 60. CONCLUSION Multiple advances in the surgical management of aortic stenosis have occured in the past decade. An evolving spectrum of surgical and transcatheter interventions is now available depending on patient age and operative risk.
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Affiliation(s)
- K E O'Sullivan
- Department of Cardiothoracic Surgery, Mater Private Hospital, Eccles St., Dublin 7, Ireland.
| | - S Bargenda
- Department of Cardiothoracic Surgery, Mater Private Hospital, Eccles St., Dublin 7, Ireland
| | - D Sugrue
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - J Hurley
- Department of Cardiothoracic Surgery, Mater Private Hospital, Eccles St., Dublin 7, Ireland
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Tokarek T, Siudak Z, Dziewierz A, Sobczyński R, Zasada W, Sorysz D, Olszewska-Wityńska K, Bryniarski K, Krawczyk-Ożóg A, Żabówka A, Sadowski J, Dudek D. Assessment of quality of life in patients after surgical and transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2016; 88:E80-8. [PMID: 26800644 DOI: 10.1002/ccd.26400] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/29/2015] [Accepted: 12/21/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Transcatheter aortic valve implantation (TAVI) and minimally invasive aortic valve replacement (mini-thoracotomy, mini-sternotomy, MIAVR) have become an appealing alternative to conventional surgical (SAVR) treatment of severe aortic stenosis (AS) in high-risk patients. BACKGROUND Aim of the study was to evaluate the quality of life (QoL) in patients with AS and treated with transfemoral TAVI, SAVR, mini-thoracotomy and mini-sternotomy. METHODS One hundred and seventy-three patients with symptomatic AS were enrolled in 2011-2013. TAVI group consisted of 39 patients (22.5%), mini-sternotomy was performed in 44 patients (25.5%), mini-thoracotomy in 50 (29%), and AVR in 40 patients (23%). QoL was assessed perioperatively, 12 and 24 months after aortic valve replacement (AVR) by Minnesota Living with Heart Failure Questionnaire (MLHFQ) and EQ-5D-3L. RESULTS Median follow-up was 583.5 (IQR: 298-736) days. Improvement of health status after procedure in comparison with pre-operative period was significantly more often reported after TAVI in perioperative period (90.3%; P = 0.004) and 12 months after procedure (100%, P = 0.02). Global MLHFQ, physical and emotional dimension score at 30-day from AVR presented significant improvement after TAVI in comparison with surgical methods (respectively: 8.3(±8.6), P = 0.003; 4.1(±5.9), P = 0.01; 1.5(±2.6), P = 0.005). Total MLHFQ score was significantly lower (better outcome) in TAVI patients 1 year after procedure (4.8(±6.8), P = 0.004), no differences in somatic and emotional component were found. No differences were found in MLHFQ score 24 months after AVR. Data from EQ-D5-3L questionnaire demonstrated significant improvement of QoL at 30-day follow-up after TAVI in comparison with surgical methods (1.2(±1.7), P = 0.0008). CONCLUSIONS TAVI improves QoL in perioperative and 12 months observation in comparison with mini-thoracotomy, mini-sternotomy and SAVR. Improvement in QoL was obtained in both generic and disease specific questionnaires. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Tomasz Tokarek
- Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland.
| | - Zbigniew Siudak
- Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland
| | - Artur Dziewierz
- 2nd Department of Cardiology, Jagiellonian University Medical College in Krakow, Poland
| | - Robert Sobczyński
- Department of Cardiovascular Surgery and Transplantology at University Hospital, Jagiellonian University Medical College in Kraków, Poland
| | - Wojciech Zasada
- 2nd Department of Cardiology, Jagiellonian University Medical College in Krakow, Poland
| | - Danuta Sorysz
- 2nd Department of Cardiology, Jagiellonian University Medical College in Krakow, Poland
| | - Katarzyna Olszewska-Wityńska
- Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland
| | - Krzysztof Bryniarski
- Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland
| | - Agata Krawczyk-Ożóg
- Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland
| | - Anna Żabówka
- Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland
| | - Jerzy Sadowski
- Department of Cardiovascular Surgery and Transplantology at University Hospital, Jagiellonian University Medical College in Kraków, Poland
| | - Dariusz Dudek
- Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland
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Abordaje mínimamente invasivo para el recambio valvular aórtico: ¿está asociado a menor transfusión de hemoderivados? CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2015.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Castedo Mejuto E, Martínez Cabeza P. Reemplazo valvular aórtico mínimamente invasivo. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Phan K, Xie A, Di Eusanio M, Yan TD. A Meta-Analysis of Minimally Invasive Versus Conventional Sternotomy for Aortic Valve Replacement. Ann Thorac Surg 2014; 98:1499-511. [DOI: 10.1016/j.athoracsur.2014.05.060] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/03/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022]
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Burdett CL, Lage IB, Goodwin AT, White RW, Khan KJ, Owens WA, Kendall SW, Ferguson JI, Dunning J, Akowuah EF. Manubrium-limited sternotomy decreases blood loss after aortic valve replacement surgery. Interact Cardiovasc Thorac Surg 2014; 19:605-10. [DOI: 10.1093/icvts/ivu196] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Minimally invasive cardiac surgery: a safe alternative for aortic valve replacement? ACTA ACUST UNITED AC 2014; 66:685-6. [PMID: 24773671 DOI: 10.1016/j.rec.2013.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 05/26/2013] [Indexed: 11/23/2022]
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Rojas SV, Haverich A. Cirugía cardiaca mínimamente invasiva: ¿una alternativa segura para pacientes que requieren recambio valvular aórtico? Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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