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Minimal Learning Curve for Minimally Invasive Aortic Valve Replacement
Dror B Leviner1,2, Tom Ronai2, Dana Abraham2
1Department of Cardiothoracic Surgery, Carmel Medical Center Cardiovascular Center, Haifa, Israel.
The Thoracic and Cardiovascular Surgeon
|June 3, 2024
Summary
Minimally invasive aortic valve replacement (MiAVR) via upper hemisternotomy shows comparable safety and outcomes to full sternotomy AVR (FSAVR). This approach reduces blood product use, even during initial learning curves.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Procedures
Background:
- Minimally invasive aortic valve replacement (MiAVR) is an established alternative to full sternotomy AVR (FSAVR).
- Despite demonstrated benefits, MiAVR adoption remains limited.
- This study evaluates early outcomes of MiAVR using an upper hemisternotomy approach.
Purpose of the Study:
- To assess the initial results of minimally invasive aortic valve replacement (MiAVR) performed via an upper hemisternotomy.
- To compare early clinical outcomes between MiAVR and traditional full sternotomy aortic valve replacement (FSAVR).
Main Methods:
- A retrospective comparison of 55 MiAVR patients with 142 historical isolated FSAVR patients.
- Primary outcome: in-hospital mortality.
- Secondary outcomes: cardiopulmonary bypass and cross-clamp times, blood transfusion rates, morbidity, and length of stay.
Main Results:
- No significant differences in preoperative characteristics or in-hospital mortality between MiAVR and FSAVR groups.
- Similar cardiopulmonary bypass and cross-clamp times were observed.
- Significantly lower intraoperative blood product transfusion rates in the MiAVR group (10.91% vs. 25.35%).
Conclusions:
- Upper hemisternotomy MiAVR is feasible and safe, yielding comparable clinical outcomes to FSAVR.
- The technique can be implemented without compromising patient safety, even during the learning curve.
- Reduced invasiveness is achievable without specialized equipment or significant technique modification.
