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Minimally Invasive vs Conventional Aortic Valve Replacement With Rapid-Deployment Bioprostheses.
Augusto D'Onofrio1, Chiara Tessari1, Giulia Lorenzoni1
1Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy.
The Annals of Thoracic Surgery
|October 11, 2020
Summary
Minimally invasive aortic valve replacement using rapid-deployment bioprostheses offers comparable clinical and hemodynamic outcomes to conventional full sternotomy. This approach should be considered a primary option for aortic valve replacement procedures.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Aortic valve replacement is a critical procedure for managing aortic valve disease.
- Rapid-deployment bioprostheses offer potential advantages in surgical approach.
- Comparing conventional full sternotomy with minimally invasive ministernotomy is essential for optimizing patient outcomes.
Purpose of the Study:
- To compare early and midterm clinical and hemodynamic results of aortic valve replacement using rapid-deployment bioprostheses.
- To evaluate outcomes between conventional full sternotomy (FS) and ministernotomy (MS) approaches.
Main Methods:
- Retrospective analysis of data from the INTU-ITA registry.
- Patients divided into FS and MS groups.
- Propensity score weighting used for data analysis to compare mortality, intraoperative variables, complications, and hemodynamic performance.
Main Results:
- No significant differences in 30-day mortality (1.6% FS vs. 0.6% MS) or survival rates at 1, 3, and 5 years between groups.
- Similar cardiopulmonary bypass times and incidence of intraoperative complications.
- Comparable device success rates (95.9%) and hemodynamic performance, including postoperative gradients and patient-prosthesis mismatch.
Conclusions:
- Minimally invasive aortic valve replacement with rapid-deployment bioprostheses yields similar surgical times and clinical/hemodynamic outcomes compared to conventional full sternotomy.
- This minimally invasive approach should be considered the first choice for aortic valve replacement.
