Abstract
(FS = 1572, MIS = 479) during the study period. The mean follow-up was 3.1 ± 2.7 years (6367 patient-years). MIS patients were significantly younger (67.8 ± 11.2 vs 70.4 ± 9.4, P< 0.001) and had a lower logistic EuroSCORE (6.6 ± 6.4% vs 11.2 ± 13.4%, P< 0.001). FS patients had a significantly shorter cross-clamp time (56.1 ± 17.3 vs 59.0 ± 16.8 min, P< 0.001), but cardiopulmonary bypass times (82.3 ± 21.7 vs 82.2 ± 25.7 min, P= 0.184) were similar. Propensity matching resulted in 477 patients from each group. After matching, there were no significant differences in any preoperative variables between groups. FS patients had a lower rate of re-exploration for bleeding than MIS patients (1.5 vs 4.2%, P= 0.019). However, MIS AVR was associated with a significantly lower 30-day mortality (0.8 vs 2.9%, P= 0.032), and a better five- and eight-year survival (89.3 ± 2.4% and 77.7 ± 4.7% vs 81.8 ± 2.2% and 72.8 ± 3.1%, P= 0.034). Cox regression analysis revealed MIS (HR 0.47, 95% CI 0.26-0.87), age (HR 1.049, 95% CI 1.021.07), preoperative liver failure (HR 5.027, 95% CI 2.51-10.08), and preoperative dialysis (HR 7.340, 95% CI 2.81-19.17) as independent predictors of long-term survival. Conclusions: MIS AVR is associated with excellent early and long-term survival and should be considered as standard of care for patients undergoing bioprosthetic AVR. Interactive CardioVascular and Thoracic Surgery
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