017 * AORTIC VALVE REPLACEMENT THROUGH AN ANTERIOR RIGHT MINI-THORACOTOMY WITH CENTRAL AORTIC CANNULATION IS SAFE

Abstract

S 28 EACTS 017 AORTIC VALVE REPLACEMENT THROUGH AN ANTERIOR RIGHT MINI-THORACOTOMY WITH CENTRAL AORTIC CANNULATION IS SAFE D. Hui, M. Bowdish, J. Cleveland, R. Ranjan, R. Sinha, C.J. Baker, M.J. Cunningham, V.A. Starnes Department of Cardiothoracic Surgery, University of Southern California, Los Angeles, United States of America Objectives: Sternotomy is the standard approach to aortic valve replacement. We have adopted an approach of minimally invasive aortic valve replacement (AVR) via a right anterior mini-thoracotomy with central arterial cannulation (MIAVR). We compared perioperative outcomes with this technique to those via sternotomy (SAVR). Methods: A prospective observational study of 492 patients who underwent isolated AVR (294 MIAVR, 198 SAVR) between March 1999 and December 2013. Univariate comparisons between groups were made using t-tests or MannWhitney U (non-normally distributed), and c tests (Fisher’s exact or Pearson) for categorical outcomes; a = 0.05 Results: The groups did not differ in age, BMI, creatinine, sex, diabetes, COPD, atrial fibrillation, history of myocardial infarction, or stroke. MIAVR patients were more likely to have a bicuspid valve (35% vs 18%, P = 0.03). In MIAVR patients, central aortic cannulation was utilized in 92% (n = 273). Venous cannulation was central in 86% (n = 255). Conversion to sternotomy was required in 6 patients (2%). Aortic cross-clamp and cardiopulmonary bypass times were similar. MIAVR patients had shorter ICU (2.8 vs 3.2 days, P < 0.01) and hospital stays (8.2 vs 9.7 days, P < 0.01), shorter time to extubation, reduced transfusions, and fewer wound infections (6.6% vs 1%, P < 0.001). Perioperative stroke (1.7% vs 2.5%) and mortality rates (1% vs 2.5%) were similar [see Table 1]. Table 1: Operative characteristics and postoperative outcomes SAVR (N = 198) MIAVR (N = 294) P-value Continued Table 1: (Continued) SAVR (N = 198) MIAVR (N = 294) P-value Valve size (mm) 23.8 ± 2.4 23.4 ± 1.9 0.13 CPB time (min) 81 ± 32 79 ± 33 0.34 Aortic cross-clamp time (min) 59 ± 26 58 ± 25 0.80 Time to extubation (min) 1074 ± 1730 800 ± 2090 <0.001 Reintubation 6 (3%) 15 (5.1%) 0.36 Intraoperative pRBC (units) 1.9 ± 2.2 1.2 ± 1.6 <0.001 Intraoperative platelets (units) 1.1 ± 1.4 0.6 ± 1.0 <0.001 ICU LOS (days) 3.2 ± 2.9 2.8 ± 3.8 <0.001 Hospital LOS (days) 9.7 ± 5.8 8.2 ± 5.7 <0.001 Postoperative pacemaker 10 (5.1%) 11 (3.7%) 0.50 Postoperative arrhythmia 55 (28.4%) 88 (29.9%) 0.76 Postoperative wound infection 13 (6.6%) 3 (1%) 0.001 Postoperative stroke 5 (2.5%) 5 (1.7%) 4 (1.4%) 0.53 GI bleed 0 (0%) 1 (0.3%) 1.0 Mortality 5 (2.5%) 3 (1%) 0.28 Conclusion: MIAVR via an anterior right mini-thoracotomy with central cannulation results in similar perioperative mortality and stroke rates as compared to standard sternotomy. In addition, the MIAVR technique resulted in earlier extubation, fewer wound infections, reduced intraoperative transfusions, and shorter ICU and hospital stays. As compared to standard sternotomy AVR, our technique of MIAVR with preferential central cannulation appears safe. Interactive CardioVascular and Thoracic Surgery Sunday A bsracts 01 –06