Propensity-score matched comparison between minimally invasive and conventional aortic valve replacement

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Procedures
• Aortic Valve Replacement

Background:

• Conventional aortic valve replacement (AVR) is the gold standard for treating aortic valve disease.
• Minimally invasive aortic valve replacement (mini-AVR) techniques aim to reduce surgical trauma and improve patient recovery.
• Comparative outcome data for mini-AVR versus conventional AVR is crucial for guiding clinical practice.

Purpose of the Study:

• To compare the clinical outcomes of minimally invasive aortic valve replacement (mini-AVR) with conventional aortic valve replacement (fs-AVR).
• To evaluate the impact of surgical approach on blood product consumption and other key clinical endpoints.
• To assess the learning curve and evolution of outcomes in mini-AVR over time.

Main Methods:

• Retrospective review of isolated AVR procedures performed between 2010 and 2020.
• Comparison of mini-AVR patients with conventional fs-AVR patients using propensity score matching.
• Primary outcome: blood product consumption. Secondary outcomes: stroke, dialysis, new AV block, mortality, and cross-clamp time.

Main Results:

• After propensity score matching, mini-AVR was associated with significantly lower blood product consumption compared to fs-AVR.
• Incidences of stroke, dialysis, new AV block, and mortality were comparable between the two groups.
• Learning curve analysis revealed reduced blood product use and shorter cross-clamp times in later stages of mini-AVR experience.

Conclusions:

• Minimally invasive aortic valve replacement (mini-AVR) demonstrates reduced blood product requirements compared to conventional surgery.
• Clinical outcomes such as stroke, dialysis, and mortality are similar between mini-AVR and fs-AVR.
• The findings support the broader implementation of mini-AVR in specialized centers with established expertise.