A Propensity Score Analysis of Early and Long-Term Outcomes of Retrograde Arterial Perfusion for Endoscopic and Minimally Invasive Heart Valve Surgery in Both Young and Elderly Patients.

Hind Elhassan,Joseph Zacharias,Andrew Knowles,Palanikumar Saravanan,Grzegorz Laskawski,Rebecca Taylor,Abdelrahman Abdelbar

doi:10.3390/jcdd9020044

Abstract

(1) Background: Minimal invasive cardiac surgery via right anterolateral thoracotomy for heart valve surgery and other intracardiac procedures proven to have lower postoperative complications. We aim to compare the neurological complications and post-operative outcomes in two cohort groups as well as survival rates up to 5 years postoperatively; (2) Methodology: Retrospective observational study for patients who had minimally invasive cardiac valve surgery with retrograde femoral arterial perfusion between 2007 and 2021 (n = 596) and the categorized patients into two groups based on their age (≥70 years old and below 70). Propensity match analysis was conducted. The primary endpoint consisted of major postoperative complications and the secondary endpoint was the long-term survival rate. (3) Results: There was no difference between the two groups in terms of postoperative outcomes. Patients ≥ 70 years old had no increased risk for neurological complications (p = 0.75) compared with those below 70 years old. The mortality rate was also not significant between the two groups (p = 0.37) as well as the crude survival rates. (4) Conclusions: The use of retrograde femoral arterial perfusion in elderly patients is not associated with increased risk compared to the younger patients’ group for a spectrum of primary cardiac valve procedures. Hence, minimally invasive approaches could be offered to elderly patients who might benefit from it.

Highlights

Minimal invasive cardiac surgery (MICS) has become an acceptable approach for cardiac valve procedures [1]
Minimal invasive cardiac surgery compared with the conventional median sternotomy is proven to be more cosmetic and has lower postoperative complications in terms of post-operative pain, reduced bleeding and need for transfusions, atrial fibrillation (AF), chest tube drainage, duration of ventilation, intensive care unit (ICU)
We aim to establish the safety of minimally invasive primary valve procedures in selected elderly patients with retrograde femoral arterial perfusion by examining post-operative in-hospital outcomes and long-term survival compared to their younger cohort

Summary

Introduction

Minimal invasive cardiac surgery (MICS) has become an acceptable approach for cardiac valve procedures [1]. Minimal invasive cardiac surgery compared with the conventional median sternotomy is proven to be more cosmetic and has lower postoperative complications in terms of post-operative pain, reduced bleeding and need for transfusions, atrial fibrillation (AF), chest tube drainage, duration of ventilation, intensive care unit (ICU). Minimally invasive surgery often requires the use of retrograde arterial perfusion from the femoral vessels, the use of retrograde femoral perfusion in minimally invasive surgery has been debatable especially in elderly patients due to the potential risk of embolic stroke [6,7]. We aim to establish the safety of minimally invasive primary valve procedures in selected elderly patients with retrograde femoral arterial perfusion by examining post-operative in-hospital outcomes and long-term survival compared to their younger cohort

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