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Minimally Invasive Versus Conventional Aortic Valve Replacement: A Propensity-Matched Study From the UK National

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.

Innovations (Philadelphia, Pa.)
|March 2, 2016
PubMed
Summary

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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.

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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).