Issue |
J Extra Corpor Technol
Volume 52, Number 2, June 2020
|
|
---|---|---|
Page(s) | 90 - 95 | |
DOI | https://doi.org/10.1051/ject/202052090 | |
Published online | 15 June 2020 |
Original Articles
Minimally Invasive Aortic Valve Replacement on Minimally Invasive Extracorporeal Circulation: Going beyond Aesthetics
Department of Cardiac Surgery, Numune Training & Research Hospital, Ankara, Turkey; and Department of Cardiac Surgery, New York Medical College, Valhalla, New York
Address correspondence to: Serdar Gunaydin, Department of Cardiovascular Surgery, City Hospital, Angora Evleri G-8 Bl. No. 1, Ankara 06836, Turkey. E-mail: serdarkvc@gmail.com
Received:
22
March
2020
Accepted:
14
May
2020
We present our multidisciplinary and multistep strategy in patients undergoing minimally invasive aortic valve replacement (mAVR) on minimally invasive extracorporeal circulation (MiECC) compared with control groups of a single strategy and conventional techniques. This cohort study included high-risk patients (Society of Thoracic Surgeons [STS] risk score >8%) undergoing aortic valve surgery under different strategies during the period from January 2017 until March 2019. Patients were matched for age, gender, body mass index, and STS score: group 1 (MiAVR) based on a minimally invasive technique with J-mini-sternotomy, rapid deployment valve (RDV), and type IV customized MiECC; group 2 (control-mAVR) consisted of minimally invasive technique with only J mini-sternotomy and RDV on a conventional extracorporeal system; group 3 (control-MiECC): full sternotomy and type IV customized MiECC; and group 4 (control): full sternotomy on a conventional extracorporeal system. The MiAVR group had significantly less duration of x-clamp time (35.4 ± 11 minutes), postoperative respiratory support (4.1 ± 1 hour), postoperative hemorrhage (250 ± 50 mL), and intensive care unit stay (1 ± .5 days) than the control-conventional (group 4) group. Seventy-six percent of patients did not receive any blood products in MiAVR (p = .025 vs. group 4). Incidence of atrial fibrillation (8%) and low cardiac output (14%) in MiAVR were significantly better than control. Critics of minimally invasive techniques sustain that potential advantages are offset by a longer cross-clamp and cardiopulmonary bypass duration, which may translate into inferior clinical outcomes. We advocate that our multidisciplinary approach supported by multiple technologies may be associated with faster recovery and superior outcomes than conventional minimally/conventional techniques.
Key words: aortic valve / replacement / minimally invasive surgery / cardiopulmonary bypass / aorta
© 2020 AMSECT
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