• Ann. Thorac. Surg. · Sep 2013

    Comparative Study

    Minimally invasive and conventional aortic valve replacement: a propensity score analysis.

    • Daniyar Gilmanov, Stefano Bevilacqua, Michele Murzi, Alfredo G Cerillo, Tommaso Gasbarri, Enkel Kallushi, Antonio Miceli, and Mattia Glauber.
    • Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa, Italy. drgilmanov@hotmail.it
    • Ann. Thorac. Surg. 2013 Sep 1;96(3):837-43.

    BackgroundThe study aimed to compare the short-term results of aortic valve replacement through minimally invasive and sternotomy approaches.MethodsThis is a retrospective, observational, cohort study of prospectively collected data on 709 patients undergoing isolated primary aortic valve replacement between 2004 and 2011. Of these, 338 were performed through either right anterior minithoracotomy or upper ministernotomy. With propensity score matching, 182 patients (minimally invasive group) were compared with 182 patients in conventional sternotomy (control group).ResultsAfter propensity matching, the 2 groups were comparable in terms of preoperative characteristics. Cardiopulmonary bypass time (117.5 vs 104.1 min, p<0.0001) and aortic cross-clamping time (83.8 vs 71.3 min, p<0.0001) were longer in the minimally invasive group, with no difference in length of stay (median 6 vs 5 days, p=0.43), but shorter assisted ventilation time (median 8 vs 7 hours, p=0.022). Overall in-hospital mortality was identical between the groups (1.64 vs 1.64%, p=1.0). No difference in the incidence of major and minor postoperative complications and related morbidity was observed. Minimally invasive aortic valve replacement was associated with a lower incidence of new onset postoperative atrial fibrillation (21% vs 31%, p=0.04). Reduction of the complication rate was observed. Median transfusion pack per patient was higher in the control group (2 vs 1 units, p=0.04).ConclusionsOur experience shows that mini-access isolated aortic valve surgery is a reproducible, safe, and effective procedure and reduces assisted ventilation duration, the need for blood product transfusion, and incidence of post-surgery atrial fibrillation.Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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