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Less-Invasive Aortic Valve Replacement: Trends and Outcomes From The Society of Thoracic Surgeons Database
Mehrdad Ghoreishi1, Vinod H Thourani2, Vinay Badhwar3
1Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
The Annals of Thoracic Surgery
|August 25, 2020
Summary
Less-invasive aortic valve replacement (AVR) shows similar operative mortality and stroke rates compared to full sternotomy. This approach offers a benchmark for comparing surgical AVR with transcatheter AVR in low-risk patients.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
Background:
- Conventional aortic valve replacement (AVR) involves full sternotomy.
- Less-invasive (LI) AVR approaches, including partial sternotomy and right thoracotomy, are gaining traction.
Purpose of the Study:
- To compare outcomes of conventional (full sternotomy) versus less-invasive AVR techniques.
- To evaluate the safety and efficacy of different AVR approaches using a large national database.
Main Methods:
- Analysis of 122,474 isolated primary AVR patients from The Society of Thoracic Surgeons database (2011-2017).
- Categorization into full sternotomy (FS), partial sternotomy (PS), and right thoracotomy (RT) groups.
- Risk adjustment to compare outcomes across different surgical approaches.
Main Results:
- The rate of LI-AVR increased from 17% to 23% between 2011 and 2016.
- No significant differences in unadjusted or adjusted operative mortality and postoperative stroke rates were observed among FS, PS, and RT groups.
- PS-AVR was associated with less prolonged ventilation and atrial fibrillation; RT-AVR showed lower transfusion rates and renal failure incidence.
Conclusions:
- Less-invasive AVR demonstrates comparable operative mortality and stroke rates to full sternotomy.
- LI-AVR serves as a valuable benchmark for comparing surgical AVR with transcatheter aortic valve replacement in low-risk populations.