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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Propensity score-matched analysis of aortic valve replacement by mini-thoracotomy
Elfriede Ruttmann1, Thomas S Gilhofer, Hanno Ulmer
1Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. elfriede.ruttmann@i-med.ac.at
The Journal of Heart Valve Disease
|November 9, 2010
Summary
Minimally invasive aortic valve replacement (MIAVR) can be safely implemented, showing similar early outcomes to conventional sternotomy. However, MIAVR is associated with longer operative times and potential groin complications from femoral cannulation.
Area of Science:
- Cardiac Surgery
- Minimally Invasive Procedures
- Aortic Valve Replacement
Background:
- Minimally invasive aortic valve replacement (MIAVR) reduces surgical trauma but is not widely adopted.
- Implementation of MIAVR programs is crucial for expanding access to this technique.
Purpose of the Study:
- To demonstrate the successful implementation of a MIAVR program at Innsbruck Medical University.
- To compare the outcomes of MIAVR with conventional aortic valve replacement (AVR) via sternotomy.
Main Methods:
- 315 patients underwent elective isolated AVR; 87 (27.6%) received MIAVR, 228 conventional AVR.
- Propensity score matching (1:1) was used to compare MIAVR with conventional AVR groups.
- Femoral artery cannulation was used in 87% of MIAVR patients.
Main Results:
- MIAVR had significantly longer operative, bypass, and cross-clamp times compared to matched AVR.
- One-year survival was comparable: 96% for MIAVR vs. 98% for AVR (p=0.57).
- MIAVR showed a trend towards higher renal insufficiency (p=0.07) and groin complications (6.9%).
Conclusions:
- MIAVR can be safely implemented as a routine cardiac surgery procedure.
- Early postoperative outcomes of MIAVR are comparable to the sternotomy approach.
- Postoperative complications in MIAVR were primarily linked to femoral cannulation.
