Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov 1;58(5):1063-1071.
doi: 10.1093/ejcts/ezaa154.

Minimally invasive access type related to outcomes of sutureless and rapid deployment valves

Martin Andreas  1 , Paolo Berretta  2 , Marco Solinas  3 , Giuseppe Santarpino  4   5 , Utz Kappert  6 , Antonio Fiore  7 , Mattia Glauber  8 , Martin Misfeld  9   10 , Carlo Savini  11 , Elisa Mikus  12 , Emmanuel Villa  13 , Kevin Phan  14 , Theodor Fischlein  5 , Bart Meuris  15 , Gianluca Martinelli  16 , Kevin Teoh  17 , Carmelo Mignosa  18 , Malakh Shrestha  19 , Thierry P Carrel  20 , Tristan Yan  10   14 , Guenther Laufer  1 , Marco Di Eusanio  2   14
Affiliations

Minimally invasive access type related to outcomes of sutureless and rapid deployment valves

Martin Andreas et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: Minimally invasive surgical techniques with optimal outcomes are of paramount importance. Sutureless and rapid deployment aortic valves are increasingly implanted via minimally invasive approaches. We aimed to analyse the procedural outcomes of a full sternotomy (FS) compared with those of minimally invasive cardiac surgery (MICS) and further assess MICS, namely ministernotomy (MS) and anterior right thoracotomy (ART).

Methods: We selected all isolated aortic valve replacements in the Sutureless and Rapid Deployment Aortic Valve Replacement International Registry (SURD-IR, n = 2257) and performed propensity score matching to compare aortic valve replacement through FS or MICS (n = 508/group) as well as through MS and ART accesses (n = 569/group).

Results: Postoperative mortality was 1.6% in FS and MICS patients who had a mean logistic EuroSCORE of 11%. Cross-clamp and cardiopulmonary bypass (CPB) times were shorter in the FS group than in the MICS group (mean difference 3.2 and 9.2 min; P < 0.001). Patients undergoing FS had a higher rate of acute kidney injury (5.6% vs 2.8%; P = 0.012). Direct comparison of MS and ART revealed longer mean cross-clamp and CPB times (12 and 16.7 min) in the ART group (P < 0.001). The postoperative outcome revealed a higher stroke rate (3.2% vs 1.2%; P = 0.043) as well as a longer postoperative intensive care unit [2 (1-3) vs 1 (1-3) days; P = 0.009] and hospital stay [11 (8-16) vs 8 (7-12) days; P < 0.001] in the MS group than in the ART group.

Conclusions: According to this non-randomized international registry, FS resulted in a higher rate of acute kidney injury. The ART access showed a lower stroke rate than MS and a shorter hospital stay than all other accesses. All these findings may be related to underlying patient risk factors.

Keywords: Aortic valve replacement; Rapid deployment valve; Sutureless and Rapid Deployment Aortic Valve Replacement International Registry; Sutureless valve; The International Valvular Surgery Study Group.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
Surgical access distribution per centre. ART: anterior right thoracotomy.
None
See this image and copyright information in PMC

References

    1. Miceli A, Santarpino G, Pfeiffer S, Murzi M, Gilmanov D, Concistre G. et al. Minimally invasive aortic valve replacement with Perceval S sutureless valve: early outcomes and one-year survival from two European centers. J Thorac Cardiovasc Surg 2014;148:2838–43. - PubMed
    1. Andreas M, Wallner S, Habertheuer A, Rath C, Schauperl M, Binder T. et al. Conventional versus rapid-deployment aortic valve replacement: a single-centre comparison between the Edwards Magna valve and its rapid-deployment successor. Interact CardioVasc Thorac Surg 2016;22:799–805. - PMC - PubMed
    1. Berretta P, Andreas M, Carrel TP, Solinas M, Teoh K, Fischlein T. et al. Minimally invasive aortic valve replacement with sutureless and rapid deployment valves: a report from an international registry (Sutureless and Rapid Deployment International Registry). Eur J Cardiothorac Surg 2019;56:793–9. - PubMed
    1. Laborde F, Fischlein T, Hakim-Meibodi K, Misfeld M, Carrel T, Zembala M. et al. Clinical and haemodynamic outcomes in 658 patients receiving the Perceval sutureless aortic valve: early results from a prospective European multicentre study (the Cavalier Trial). Eur J Cardiothorac Surg 2016;49:978–86. - PubMed
    1. Kocher A, Coti I, Laufer G, Andreas M.. Minimally invasive aortic valve replacement through an upper hemisternotomy: the Vienna technique. Eur J Cardiothorac Surg 2018;53:ii29–31. - PubMed

MeSH terms