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Minimally Invasive Versus Conventional Aortic Valve Replacement: A Propensity-Matched Study From the UK National Data
Rizwan Q Attia1, Graeme L Hickey, Stuart W Grant
1From the *Department of Cardiothoracic Surgery, Guy's and St Thomas' Hospital, London, UK; †Centre for Health Informatics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; ‡National Institute for Cardiovascular Outcomes Research, Institute of Cardiovascular Science, University College London, London, UK; §Department of Cardiothoracic Surgery, Manchester Academic Health Science Centre, University Hospital of South Manchester, Wythenshawe, UK; ∥Department of Cardiothoracic Surgery, Morriston Hospital, Morriston, Swansea, UK; ¶Department of Cardiothoracic Surgery North Staffordshire Royal Infirmary, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK; #Department of Cardiothoracic Surgery, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK; **Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Victoria Hospital NHS Trust, Blackpool, UK; ††Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK; and ‡‡Department of Cardiothoracic Surgery, The Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK.
Objective:
Minimally invasive aortic valve replacement (MIAVR) has been demonstrated as a safe and effective option but remains underused. We aimed to evaluate outcomes of isolated MIAVR compared with conventional aortic valve replacement (CAVR).
Methods:
Data from The National Institute for Cardiovascular Outcomes Research (NICOR) were analyzed at seven volunteer centers (2006-2012). Primary outcomes were in-hospital mortality and midterm survival. Secondary outcomes were postoperative length of stay as well as cumulative bypass and cross-clamp times. Propensity modeling with matched cohort analysis was used.
Results:
Of 307 consecutive MIAVR patients, 151 (49%) were performed during the last 2 years of study with a continued increase in numbers. The 307 MIAVR patients were matched on a 1:1 ratio. In the matched CAVR group, there was no statistically significant difference in in-hospital mortality [MIAVR, 4/307,(1.3%); 95% confidence interval (CI), 0.4%-3.4% vs CAVR, 6/307 (2.0%); 95% CI, 0.8%-4.3%; P = 0.752]. One-year survival rates in the MIAVR and CAVR groups were 94.4% and 94.6%, respectively. There was no statistically significant difference in midterm survival (P = 0.677; hazard ratio, 0.90; 95% CI, 0.56-1.46). Median postoperative length of stay was lower in the MIAVR patients by 1 day (P = 0.009). The mean cumulative bypass time (94.8 vs 91.3 minutes; P = 0.333) and cross-clamp time (74.6 vs 68.4 minutes; P = 0.006) were longer in the MIAVR group; however, this was significant only in the cross-clamp time comparison.
Conclusions:
Minimally invasive aortic valve replacement is a safe alternative to CAVR with respect to operative and 1-year mortality and is associated with a shorter postoperative stay. Further studies are required in high-risk (logistic EuroSCORE > 10) patients to define the role of MIAVR.
Insights
Minimally invasive aortic valve replacement (MIAVR) is as safe as conventional aortic valve replacement (CAVR) regarding mortality and offers a shorter hospital stay. Further research is needed for high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Aortic Valve Replacement
Background:
- Minimally invasive aortic valve replacement (MIAVR) is a safe and effective procedure but is underutilized.
- Conventional aortic valve replacement (CAVR) is the standard treatment for aortic valve disease.
Purpose of the Study:
- To compare the outcomes of isolated MIAVR with CAVR.
- To assess the safety and efficacy of MIAVR versus CAVR.
Main Methods:
- Analysis of data from The National Institute for Cardiovascular Outcomes Research (NICOR) from 2006-2012.
- Utilized propensity modeling with matched cohort analysis for 307 MIAVR patients and matched CAVR controls.
- Primary outcomes included in-hospital mortality and midterm survival; secondary outcomes included length of stay and procedural times.
Main Results:
- No statistically significant difference in in-hospital mortality between MIAVR (1.3%) and CAVR (2.0%).
- One-year survival rates were comparable (94.4% for MIAVR vs. 94.6% for CAVR).
- MIAVR was associated with a significantly shorter postoperative length of stay (by 1 day) and longer cross-clamp times.
Conclusions:
- MIAVR is a safe alternative to CAVR with similar operative and 1-year mortality.
- MIAVR offers the benefit of a shorter postoperative hospital stay.
- Further investigation is warranted for MIAVR in high-risk patients (logistic EuroSCORE > 10).