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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.
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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
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El-Andari R, Fialka NM, Shan S, White A, Manikala VK, Wang S. Aortic Valve Replacement: Is Minimally Invasive Really Better? A Contemporary Systematic Review and Meta-Analysis. Cardiol Rev 2024; 32:217-242. [PMID: 36728720 DOI: 10.1097/crd.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In recent years, minimally invasive cardiac surgery has increased in prevalence. There has been significant debate regarding the optimal approach to isolated aortic valve replacement between conventional midline sternotomy and minimally invasive approaches. We performed a systematic review of the contemporary literature comparing minimally invasive to full sternotomy aortic valve replacement. PubMed and Embase were systematically searched for articles published from 2010-2021. A total of 1215 studies were screened and 45 studies (148,606 patients total) met the inclusion criteria. This study found rates of in-hospital mortality were higher with full sternotomy than ministernotomy ( P = 0.02). 30-day mortality was higher with full sternotomy compared to right anterior thoracotomy ( P = 0.006). Renal complications were more common with full sternotomy versus ministernotomy ( P < 0.00001) and right anterior thoracotomy ( P < 0.0001). Rates of wound infections were greater with full sternotomy than ministernotomy ( P = 0.02) and right anterior thoracotomy ( P < 0.00001). Intensive care unit length of stay ( P = 0.0001) and hospital length of stay ( P < 0.0001) were shorter with ministernotomy compared to full sternotomy. This review found that minimally invasive approaches to isolated aortic valve replacement result in reduced early mortality and select measures of postoperative morbidity; however, long-term mortality is not significantly different based on surgical approach. An analysis of mortality alone is not sufficient for the selection of the optimal approach to isolated aortic valve replacement. Surgeon experience, individual patient characteristics, and preference require thorough consideration, and additional studies investigating quality of life measures will be imperative in identifying the optimal approach to isolated aortic valve replacement.
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Affiliation(s)
- Ryaan El-Andari
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Nicholas M Fialka
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Shubham Shan
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Abigail White
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Vinod K Manikala
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Shaohua Wang
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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3
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Yang NK, Soliman FK, Pepe RJ, Palte NK, Yoo J, Nithikasem S, Laraia KN, Chakraborty A, Chao JC, Sunagawa G, Takebe M, Lemaire A, Ikegami H, Russo MJ, Lee LY. Minimally invasive approach associated with lower resource utilization after aortic and mitral valve surgery. JTCVS OPEN 2023; 15:72-80. [PMID: 37808048 PMCID: PMC10556938 DOI: 10.1016/j.xjon.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/21/2023] [Accepted: 06/05/2023] [Indexed: 10/10/2023]
Abstract
Objective To investigate the effect of minimally invasive cardiac surgery (MICS) on resource utilization, cost, and postoperative outcomes in patients undergoing left-heart valve operations. Methods Data were retrospectively reviewed for patients undergoing single-valve surgery (eg, aortic valve replacement, mitral valve replacement, or mitral valve repair) at a single center from 2018 to 2021, stratified by surgical approach: MICS vs full sternotomy (FS). Baseline characteristics and postoperative outcomes were compared. Primary outcome was high resource utilization, defined as direct procedure cost higher than the third quartile or either postoperative LOS ≥7 days or 30-day readmission. Secondary outcomes were direct cost, length of stay, 30-day readmission, in-hospital and 30-day mortality, and major morbidity. Multiple regression analysis was conducted, controlling for baseline characteristics, operative approach, valve operation, and lead surgeon to assess high resource utilization. Results MICS was correlated with a significantly lower rate of high resource utilization (MICS, 31.25% [n = 115] vs FS 61.29% [n = 76]; P < .001). Median postoperative length of stay (MICS, 4 days [range, 3-6 days] vs FS, 6 days [range, 4 to 9 days]; P < .001) and direct cost (MICS, $22,900 [$19,500-$28,600] vs FS, $31,900 [$25,900-$50,000]; P < .001) were lower in the MICS group. FS patients were more likely to experience postoperative atrial fibrillation (P = .040) and renal failure (P = .027). Other outcomes did not differ between groups. Controlling for stratified Society of Thoracic Surgeons predicted risk of mortality, cardiac valve operation, and lead surgeon, FS demonstrated increased likelihood of high resource utilization (P < .001). Conclusions MICS for left-heart valve pathology demonstrated improved postoperative outcomes and resource utilization.
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Affiliation(s)
- NaYoung K. Yang
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Fady K. Soliman
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Russell J. Pepe
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Nadia K. Palte
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jin Yoo
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sorasicha Nithikasem
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Kayla N. Laraia
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Abhishek Chakraborty
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Joshua C. Chao
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Gengo Sunagawa
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Manabu Takebe
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Anthony Lemaire
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Hirohisa Ikegami
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Mark J. Russo
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Leonard Y. Lee
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Robert Wood Johnson University Hospital, New Brunswick, NJ
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Mohamed MA, Ding S, Ali Shah SZ, Li R, Dirie NI, Cheng C, Wei X. Comparative Evaluation of the Incidence of Postoperative Pulmonary Complications After Minimally Invasive Valve Surgery vs. Full Sternotomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Propensity Score-Matched Studies. Front Cardiovasc Med 2021; 8:724178. [PMID: 34497838 PMCID: PMC8419439 DOI: 10.3389/fcvm.2021.724178] [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: 06/12/2021] [Accepted: 07/27/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Postoperative pulmonary complications remain a leading cause of increased morbidity, mortality, longer hospital stays, and increased costs after cardiac surgery; therefore, our study aims to analyze whether minimally invasive valve surgery (MIVS) for both aortic and mitral valves can improve pulmonary function and reduce the incidence of postoperative pulmonary complications when compared with the full median sternotomy (FS) approach. Methods: A comprehensive systematic literature research was performed for studies comparing MIVS and FS up to February 2021. Randomized controlled trials (RCTs) and propensity score-matching (PSM) studies comparing early respiratory function and pulmonary complications after MIVS and FS were extracted and analyzed. Secondary outcomes included intra- and postoperative outcomes. Results: A total of 10,194 patients from 30 studies (6 RCTs and 24 PSM studies) were analyzed. Early mortality differed significantly between the groups (MIVS 1.2 vs. FS 1.9%; p = 0.005). Compared with FS, MIVS significantly lowered the incidence of postoperative pulmonary complications (odds ratio 0.79, 95% confidence interval [0.67, 0.93]; p = 0.004) and improved early postoperative respiratory function status (mean difference -24.83 [-29.90, -19.76]; p < 0.00001). Blood transfusion amount was significantly lower after MIVS (p < 0.02), whereas cardiopulmonary bypass time and aortic cross-clamp time were significantly longer after MIVS (p < 0.00001). Conclusions: Our study showed that minimally invasive valve surgery decreases the incidence of postoperative pulmonary complications and improves postoperative respiratory function status.
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Affiliation(s)
- Mohamed Abdulkadir Mohamed
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuai Ding
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sayed Zulfiqar Ali Shah
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Li
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Najib Isse Dirie
- Division of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cai Cheng
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Wei
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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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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6
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The learning curve of minimally invasive aortic valve replacement for aortic valve stenosis. Gen Thorac Cardiovasc Surg 2019; 68:565-570. [DOI: 10.1007/s11748-019-01234-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/15/2019] [Indexed: 01/19/2023]
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7
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Ueno G, Ohno N. Aortic valve approaches in the era of minimally invasive cardiac surgery. Surg Today 2019; 50:815-820. [PMID: 31342159 DOI: 10.1007/s00595-019-01848-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/21/2019] [Indexed: 12/23/2022]
Abstract
The concept of minimally invasive cardiac surgery has been gradually adopted world-wide since its inception more than 2 decades ago. Recently, catheter intervention has been used in the treatment of structural heart disease. Most notably, minimally invasive transcatheter aortic valve implantation is now an established treatment option for aortic valve stenosis. There are three major approaches for minimally invasive aortic valve surgery: via median sternotomy, via the parasternal approach, and via the thoracotomy approach. All these approaches allow for a small skin incision and/or avoid full sternotomy. Moreover, several advanced variations with additional aortic procedures or totally endoscopic management have been developed. When considering each approach, low invasiveness must be balanced with safety, as surgeons broaden their insight of advanced medicine. Physical invasiveness is largely related to the surgical approach in minimally invasive surgery. We review the history and evolution of the different surgical approaches for minimally invasive aortic valve replacement.
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Affiliation(s)
- Go Ueno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan.
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8
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Elattar MA, Kaya A, Planken NR, Baan J, Vanbavel ET, de Mol BAJM, Marquering HA. A computed tomography-based planning tool for predicting difficulty of minimally invasive aortic valve replacement. Interact Cardiovasc Thorac Surg 2018; 27:505-511. [PMID: 29659843 DOI: 10.1093/icvts/ivy128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 03/21/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Minimally invasive aortic valve replacement has proven its value over the last decade by its significant advancement and reduction in mortality, morbidity and admission time. However, minimally invasive aortic valve replacement is associated with some on-site difficulties such as limited aortic annulus exposure. Currently, computed tomography scans are used to evaluate the anatomical relationship among the intercostal spaces, ascending aorta and aortic valve prior to surgery. We hypothesized that quantitative measurements of access distance and access angle are associated with outcome and access difficulty. METHODS We introduce a novel minimally invasive aortic valve replacement planning prototype that allows automatic measurements of access angle, access distance and aortic annulus dimensions. The prototype visualizes these measurements on the chest cage as ISO contours. The association of these measures with outcome parameters such as extracorporeal circulation time, aortic cross-clamping time and access difficulty score was assessed. We included 14 patients who received a new valve by ministernotomy. RESULTS The mean access angle was 40.3 ± 5.1°. It was strongly associated with aortic cross-clamping time (Pearson correlation coefficient = 0.60, P = 0.02) and access difficulty score (Spearman's rank correlation coefficient = 0.57, P = 0.03). Access angles were significantly different between easy and difficult access groups (P = 0.03). There was no significant association between access distance and outcome parameters. CONCLUSIONS Access angle is strongly associated with procedure complexity. The automated presentation of this measure suggests added value of the prototype in clinical practice.
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Affiliation(s)
- Mustafa A Elattar
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Informatics Science, Communication and Information Technology School, Nile University, Giza, Egypt
| | - Abdullah Kaya
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Nils R Planken
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jan Baan
- Department of Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Ed T Vanbavel
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Bas A J M de Mol
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Totsugawa T, Hiraoka A, Tamura K, Yoshitaka H, Sakaguchi T. Minimally invasive aortic valve replacement through a right anterolateral mini-thoracotomy for the treatment of octogenarians with aortic valve stenosis. Heart Vessels 2018; 34:462-469. [PMID: 30225808 DOI: 10.1007/s00380-018-1262-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 09/14/2018] [Indexed: 11/28/2022]
Abstract
Because of concerns about the high risk of perioperative complications, the feasibility of minimally invasive aortic valve replacement (MIAVR) for elderly patients remains controversial. Here, we review our results of MIAVR in octogenarians with aortic valve stenosis (AS). Between October 2012 and December 2017, 110 patients with AS underwent MIAVR via a right anterolateral mini-thoracotomy; 41 patients were octogenarian (Group O). The perioperative outcomes of these patients were compared with those of the 69 patients who were less than 80 years of age (Group Y). A preoperative contrast-enhanced computed tomography (CT) scan was performed in all patients to guide the patient selection and aid the decision regarding cannulation sites. Among all cases of isolated aortic valve replacement, MIAVR accounted for 47% cases during this study period. The mean age of Group O was 83.6 ± 2.9 years, with a maximum age of 89. In Group O, there were no in-hospital deaths or morbidity, including stroke. The rate of blood transfusion was significantly higher in Group O than in Group Y (P = 0.01). However, there was no significant difference in ventilation time, the length of intensive care unit stay, the length of hospital stay, or in the rates of cumulative survival and freedom from valve-related complications. With careful patient selection and a perfusion strategy based on preoperative CT scan, equivalent outcomes of MIAVR were even achieved in octogenarians.
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Affiliation(s)
- Toshinori Totsugawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Kita-ku, Okayama, 700-0804, Japan.
| | - Arudo Hiraoka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Kita-ku, Okayama, 700-0804, Japan
| | - Kentaro Tamura
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Kita-ku, Okayama, 700-0804, Japan
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Kita-ku, Okayama, 700-0804, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Kita-ku, Okayama, 700-0804, Japan
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Kondo N, Totsugawa T, Hiraoka A, Tamura K, Yoshitaka H, Sakaguchi T. Left Atrial Appendage Resection during Minimally Invasive Aortic Valve Surgery via Right Minithoracotomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200513] [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]
Affiliation(s)
- Nobuo Kondo
- From the Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Toshinori Totsugawa
- From the Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Arudo Hiraoka
- From the Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kentaro Tamura
- From the Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Hidenori Yoshitaka
- From the Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Taichi Sakaguchi
- From the Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
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11
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Left Atrial Appendage Resection During Minimally Invasive Aortic Valve Surgery via Right Minithoracotomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:378-379. [PMID: 28746063 DOI: 10.1097/imi.0000000000000388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Here, we report concomitant resection of the left atrial appendage through the transverse sinus during minimally invasive aortic valve replacement via right anterolateral thoracotomy. The left atrial appendage was exposed by raising the collapsed ascending aorta and was safely resected using a surgical stapling device. This procedure is a feasible option in elderly patients, for whom a percutaneous procedure would be inappropriate, and could be useful for preventing thromboembolic and hemorrhagic complications.
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12
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Ramlawi B, Bedeir K, Lamelas J. Aortic Valve Surgery: Minimally Invasive Options. Methodist Debakey Cardiovasc J 2017; 12:27-32. [PMID: 27127559 DOI: 10.14797/mdcj-12-1-27] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Minimally invasive aortic valve surgery has not been adopted by a significant proportion of cardiac surgeons despite proven benefits. This may be related to a high learning curve and technical issues requiring retraining. In this review, we discuss the data for minimally invasive aortic valve surgery and describe our operative technique for both ministernotomy and anterior thoracotomy approaches. We also discuss the advent of novel sutureless valves and how these techniques compare to available transcatheter aortic valve procedures.
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13
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Bedeir K, Reardon M, Cohn LH, Ramlawi B. Sutureless Aortic Valves: Combining the Best or the Worst? Semin Thorac Cardiovasc Surg 2017; 28:341-352. [PMID: 28043442 DOI: 10.1053/j.semtcvs.2016.05.010] [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: 05/26/2016] [Indexed: 11/11/2022]
Abstract
Aortic valve replacement is a life saving intervention. Significant progress has been made toward reducing surgical trauma through minimally invasive surgery and transcatheter techniques. Each of these approaches has its advantages and limitations. Sutureless aortic valves have been proposed to overcome these limitations and have been in use in Europe. It is however less than clear whether these valves will prove advantageous and whether they will have a role in the future. We review the published literature for sutureless aortic valves and their performance against standard and transcatheter aortic valve replacements.
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Affiliation(s)
- Kareem Bedeir
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Reardon
- Cardiovascular surgery, Methodist DeBakey Cardiovascular Center, Houston, Texas
| | - Lawrence H Cohn
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Basel Ramlawi
- Cardiothoracic Surgery, Heart & Vascular Center, Valley Health System, Virginia.
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14
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Chu D, Vaporciyan AA, Iannettoni MD, Ikonomidis JS, Odell DD, Shemin RJ, Starnes SL, Stein W, Badhwar V. Are There Gaps in Current Thoracic Surgery Residency Training Programs? Ann Thorac Surg 2016; 101:2350-5. [DOI: 10.1016/j.athoracsur.2016.01.038] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/19/2015] [Accepted: 01/08/2016] [Indexed: 01/28/2023]
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Fattouch K, Moscarelli M, Del Giglio M, Albertini A, Comoglio C, Coppola R, Nasso G, Speziale G. Non-sutureless minimally invasive aortic valve replacement: mini-sternotomy versus mini-thoracotomy: a series of 1130 patients. Interact Cardiovasc Thorac Surg 2016; 23:253-8. [PMID: 27160409 DOI: 10.1093/icvts/ivw104] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 03/04/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Aortic valve replacement through conventional sternotomy still represents the gold-standard surgical approach for aortic valve disease. However, given the increasing number of patients with comorbidities, strategies that can improve operative results are always sought. Minimally invasive aortic valve surgery, although related to a steep learning curve, might be associated with improved postoperative outcomes. The main aim of this study was to assess whether significant differences exist in terms of operative and early results between a mini-sternotomy and a right mini-thoracotomy approach for isolated aortic valve replacement without sutureless technologies. METHODS This is an observational retrospective multicentre study from nine Italian cardiac centres that analyses prospectively collected data of patients who underwent isolated minimally invasive aortic valve replacement between January 2010 and December 2014. Two approaches are considered (mini-sternotomy and mini-thoracotomy) and compared in terms of operative and early outcomes. RESULTS After interrogation of the centralized database, a total of 1130 patients were retrieved (854 mini-sternotomy and 276 mini-thoracotomy). Patients in the mini-sternotomy group had a higher risk profile. There was no difference in terms of early mortality; cardiopulmonary bypass and cross-clamp time did not differ significantly between the groups; and a significantly higher number of reoperations for bleeding was observed in the right mini-thoracotomy group. CONCLUSIONS Both mini-sternotomy and mini-thoracotomy could be performed safely, with low mortality and postoperative morbidity. The mini-thoracotomy approach was associated with a significantly higher rate of reoperation for bleeding. Uptake among cardiac centres was low. Sutureless technologies could potentially increase surgical volume by simplifying the mini-thoracotomy procedure.
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Affiliation(s)
- Khalil Fattouch
- Department of Surgery and Cancer, University of Palermo, Italy Department of Cardiothoracic and vascular Surgery, GVM Care and Research, Villa Maria Eleonora, Palermo, Italy
| | | | - Mauro Del Giglio
- Department of Cardiac Surgery, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Alberto Albertini
- Department of Cardiac Surgery, GVM Care and Research, Salus Hospital, Ravenna, Italy
| | - Chiara Comoglio
- Department of Cardiac Surgery, GVM Care and Research, Maria Pia Hospital, Torino, Italy
| | - Roberto Coppola
- Department of Cardiac Surgery, GVM Care and Research, Istituto Clinico Ligure Alta Specialita', Rapallo, Italy
| | - Giuseppe Nasso
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
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Motomura N. Key Approach to Expanding the Less Invasive Off-Pump Coronary Artery Bypass Grafting Procedure Worldwide. Circ J 2015; 79:2106-7. [PMID: 26370170 DOI: 10.1253/circj.cj-15-0940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Noboru Motomura
- Department of Cardiovascular Surgery, Sakura Medical Center, Toho University
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Hysi I, Guesnier L, Gautier L, Fabre O. Central venous cannulation and antegrade arterial perfusion for minimally invasive aortic valve surgery: Return to the basics. Int J Cardiol 2015; 186:72-3. [PMID: 25828103 DOI: 10.1016/j.ijcard.2015.03.288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/07/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Ilir Hysi
- Department of Cardiac Surgery, Lens Hospital and Bois Bernard Private Hospital, Lens, France.
| | - Laurent Guesnier
- Department of Cardiac Surgery, Lens Hospital and Bois Bernard Private Hospital, Lens, France
| | - Laurence Gautier
- Department of Cardiac Surgery, Lens Hospital and Bois Bernard Private Hospital, Lens, France
| | - Olivier Fabre
- Department of Cardiac Surgery, Lens Hospital and Bois Bernard Private Hospital, Lens, France
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Lu S, Wei L, Sun X, Wang C. One incision, two cannulations for minimally invasive aortic valve surgery. Int J Cardiol 2015; 182:97. [PMID: 25576732 DOI: 10.1016/j.ijcard.2014.12.170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 12/31/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Shuyang Lu
- Shanghai Institute of Cardiovascular Disease, China; Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lai Wei
- Shanghai Institute of Cardiovascular Disease, China; Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiaoning Sun
- Shanghai Institute of Cardiovascular Disease, China; Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chunsheng Wang
- Shanghai Institute of Cardiovascular Disease, China; Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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Lamelas J, Nguyen TC. Minimally Invasive Valve Surgery: When Less Is More. Semin Thorac Cardiovasc Surg 2015; 27:49-56. [DOI: 10.1053/j.semtcvs.2015.02.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/11/2022]
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