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Minimally-invasive versus conventional aortic valve replacement--perioperative course and mid-term results
S Christiansen1, J Stypmann, T D Tjan
1Klinik und Poliklinik für Thorax-, Herz- und Gefässchirurgie, Westfälische Wilhelms-Universität Münster, Germany.
Objective:
We performed a case-control-study to compare perioperative and mid-term results of minimally invasive with conventional aortic valve replacement.
Methods:
Between 8/96 and 7/97, 113 patients underwent isolated aortic valve replacement (minimally invasive: 29, conventional: 84) in our Department. Diagnosis, ejection fraction, pressure gradient/regurgitation fraction, age, gender and body-mass-index were used as matching criteria for the case-control-study. For qualitative data correspondence was requested, for quantitative data deviations up to 10% were accepted. With these criteria 25 patients of the minimally invasive group were matched to 25 patients of conventional group. All patients were reexplored 1 year after aortic valve replacement. Statistical analysis was done by the Fisher's exact test for qualitative data and the Mann-Whitney test for quantitative data.
Results:
We implanted 15 (20) bioprosthesis' and 10 (five) mechanical prosthesis' in the minimally invasive, respectively, conventional group. There were no statistically significant differences between both groups with respect to the perioperative course, only duration of surgery (mean 201.6 vs. 143.9 min, P < 0.01) and extracorporeal circulation (mean 116.1 vs. 71.3 min, P < 0.01) as well as aortic-cross-clamp-time (mean 77.9 vs. 46.9 min, P < 0.01) were significantly longer in the minimally invasive group. Postoperative complications occurred in one patient of the minimally invasive group (dissection of the right coronary artery) and four patients of the conventional group (third degree AV block, pneumothorax, grand mal convulsion, cardiopulmonary resuscitation). Two patients, one of each group, died during follow-up for unknown reasons. Follow-up revealed no significant differences with respect to clinical and echocardiographic data, but the shorter skin incision was cosmetically more accepted by patients of the minimally invasive group. Minor paravalvular leaks occurred in four patients of the minimally invasive and three patients of the conventional group as diagnosed by transthoracic echocardiography.
Conclusions:
Both surgical techniques may be performed with comparable perioperative and mid-term results, but the better cosmetic result in the minimally invasive group is paid by a longer duration of surgery.
Insights
Minimally invasive aortic valve replacement offers comparable perioperative and mid-term outcomes to conventional methods, with improved cosmetic results. However, the minimally invasive approach requires a longer surgical duration.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Aortic Valve Replacement
Background:
- Conventional aortic valve replacement (AVR) is a standard procedure.
- Minimally invasive AVR techniques aim to reduce surgical trauma and improve patient outcomes.
- Comparing the efficacy and safety of these approaches is crucial for surgical decision-making.
Purpose of the Study:
- To compare the perioperative and mid-term results of minimally invasive AVR (MIAVR) versus conventional AVR (CAVR).
- To evaluate clinical and echocardiographic outcomes between the two surgical techniques.
Main Methods:
- A case-control study involving 113 patients undergoing isolated AVR (29 MIAVR, 84 CAVR) between August 1996 and July 1997.
- Patients were matched based on diagnosis, ejection fraction, pressure gradient/regurgitation fraction, age, gender, and body-mass-index.
- Statistical analysis included Fisher's exact test for qualitative data and Mann-Whitney test for quantitative data, with a 1-year follow-up.
Main Results:
- No significant differences in perioperative outcomes or mid-term clinical/echocardiographic data were observed between MIAVR and CAVR groups.
- MIAVR was associated with significantly longer surgery duration, extracorporeal circulation time, and aortic cross-clamp time.
- Postoperative complications were infrequent in both groups, with MIAVR patients reporting better cosmetic acceptance due to shorter skin incisions.
Conclusions:
- Both MIAVR and CAVR demonstrate comparable perioperative and mid-term results.
- The enhanced cosmetic outcome of MIAVR is achieved at the cost of increased surgical time.
- Patient selection and surgical expertise are key factors in optimizing outcomes for both techniques.