Bleeding in minimally invasive versus conventional aortic valve replacement

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Procedures
• Aortic Valve Replacement

Background:

• Observational studies suggest less bleeding with minimally invasive aortic valve replacement (AVR) versus full sternotomy.
• However, data from randomized controlled trials (RCTs) on this topic remain conflicting.

Purpose of the Study:

• To compare bleeding-related outcomes between minimally invasive AVR (ministernotomy) and full sternotomy AVR in adult patients with aortic stenosis.

Main Methods:

• A Swedish single-center randomized trial assigned 100 adult patients with aortic stenosis to either ministernotomy or full sternotomy AVR.
• The primary outcome was severe or massive bleeding, defined by the Universal Definition of Perioperative Bleeding (UDPB).
• Secondary outcomes included blood product transfusions, chest tube output, and re-exploration for bleeding.

Main Results:

• No significant difference in severe or massive postoperative bleeding was observed between the ministernotomy (6%) and full sternotomy (6%) groups (p=1.00).
• Mean chest tube output in the first 12 hours was similar (270 ml vs. 350 ml, p=0.08).
• Rates of packed red blood cell transfusion (36% vs. 28%, p=0.39) and re-exploration for bleeding (4% vs. 4%) were also comparable.

Conclusions:

• Minimally invasive AVR via ministernotomy did not lead to significantly less bleeding-related outcomes compared to full sternotomy AVR.
• The findings suggest that the perceived bleeding advantage of minimally invasive AVR may not be consistently demonstrated in randomized trials.