Aortic valve replacement: same operation, same outcomes but a smaller incision.

Abstract

Minimally invasive approaches are at the forefront of advancements in cardiac surgery and are playing key roles in our growing speciality. Despite the growing numbers of transcatheter aortic valve replacement, surgical aortic valve replacement (SAVR) remains at the core of treating aortic valve pathologies. SAVR remains the preferred choice for patients undergoing aortic valve surgery in young, fit patients under the age of 65 (USA)/75 (Europe). Different technical approaches have been identified to perform SAVR, such as hemi-sternotomy and right anterior thoracotomy [1]. Minimally invasive SAVR is an evolving subspeciality providing equivalent outcomes to SAVR performed through a median sternotomy whilst reducing invasiveness. Whilst these approaches are useful and reliable, careful patient selection and surgeon experience remain important factors in achieving good outcomes. In this issue of EJCTS, the study by Telyuk et al. [2] sheds light on comparing manubrium-limited mini-sternotomy versus conventional sternotomy for aortic valve replacement in the MAVRIC trial. The authors compare the long-term outcomes between hemi- and median sternotomy for surgical aortic valve replacement in 270 patients [2]. The MAVRIC trial published the trial protocol in 2017, with the primary outcome to compare the need for postoperative red cell transfusion within 7 days of index surgery between hemi- and median sternotomy for SAVR [3, 4]. Secondary outcomes included several key outcomes including but not limited to the proportion of patients receiving a red cell transfusion, volume in chest drains at 6 and 12 h, degree of aortic regurgitation using echocardiogram within 6 weeks, reoperation rates, conversion to median sternotomy intra-operatively, and postoperative quality of life using the EuroQol (EQ-5D-3 l, EQ-VAS) questionnaire at 2 days, 6 weeks and 12 weeks and, finally, cost-effectiveness analyses.