Facilitating technologies in minimally invasive aortic valve replacement: a propensity score analysis

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Procedures
• Medical Technology Innovation

Background:

• Minimally invasive aortic valve replacement (MIAVR) presents technical challenges and can lead to extended operative durations.
• Facilitating technologies (FT) aim to streamline MIAVR procedures and improve patient outcomes.

Purpose of the Study:

• To evaluate the impact of two specific facilitating technologies (Cor-Knot fastener and Custodiol-HTK solution) on intraoperative and postoperative outcomes in MIAVR.
• To assess the effectiveness of FT in reducing operative times and complications associated with MIAVR.

Main Methods:

• A retrospective analysis of 299 patients undergoing MIAVR between 2008 and 2016.
• Propensity score matching was used to compare 94 pairs of patients: 172 in the FT group and 127 in the control (No-FT) group.
• Primary endpoints included cardiopulmonary bypass and cross-clamp times; secondary endpoints encompassed blood product use, postoperative ejection fraction, ICU/hospital length of stay, mortality, and complication rates.

Main Results:

• The FT group demonstrated significant reductions in cardiopulmonary bypass (104 vs. 118 min) and cross-clamp times (78 vs. 90 min).
• FT was associated with decreased intraoperative transfusions (red blood cell, cryoprecipitate), prolonged mechanical ventilation, postoperative renal failure, and shorter hospital stays.
• No significant differences were observed in postoperative ejection fraction or the incidence of stroke, sepsis, pneumonia, pulmonary embolism, or atrial fibrillation.

Conclusions:

• Facilitating technologies significantly decrease intraoperative times, blood product utilization, need for prolonged ventilation, renal failure incidence, and hospital length of stay in MIAVR.
• Implementing FT in MIAVR can lead to more reproducible and widespread adoption of these minimally invasive surgical approaches.