Abstract
BackgroundSutureless prostheses may have added benefit when combined with minimal access surgery, although this has not been fully assessed in the literature. This study aims to provide a comparative analysis of the Perceval valve comparing median sternotomy (MS) with mini-sternotomy (MIS).MethodsA retrospective analysis of prospectively collected data was conducted for all isolated aortic valve replacement (AVR), using the Perceval valve, for severe aortic stenosis cases in the period 2014 to 2019. Patients undergoing concomitant valve or revascularisation surgery were excluded.ResultsA total of 78 patients were included: MS group 41; MIS group 37. Operatively, bypass times were comparable between MS and MIS groups (mean 89.3 vs 83.4, p = 0.307), as were aortic cross clamp times (58.4 vs 55.9, p = 0.434). There were no operative deaths or new onset post-operative neurology. MIS was a predictor of reduced stay in the intensive care unit (coef − 3.25, 95% CI [− 4.93, − 0.59], p = 0.036) and hospital stay overall (p = 0.004). Blood transfusion units were comparable as were the incidence of heart block (n = 5 vs n = 3, p = 0.429) and new onset atrial fibrillation (n = 15 vs n = 9, p = 0.250). Follow-up echocardiography found a significant improvement in effective orifice area, left ventricular dimension and volume indices, and LVEF (p > 0.05) for all patients. Multivariate analysis found mini-sternotomy to be a predictor for reduced LV diastolic volume (coef − 0.35, 95% CI [− 1.02, − 0.05], p = 0.05).ConclusionsThe combination of minimal access surgery and sutureless AVR may enhance patient recovery and provide early LV remodelling.
Highlights
The risk of complications from conventional sternotomy for aortic valve replacement (AVR) centre around deep sternal wound infection, sternal dehiscence and pain [1]
In a randomised prospective study (n = 100), Borger and colleagues [8] found that patients undergoing upper hemisternotomy and AVR with the Edwards Intuity valve had reduced cross clamp time and improved haemodynamic function compared with full sternotomy
The additive effect of sutureless technology to mini-sternotomy access can potentially circumvent the technical challenge of reduced operative space, limiting the increased operative time usually associated with miniAVR
Summary
The risk of complications from conventional sternotomy for aortic valve replacement (AVR) centre around deep sternal wound infection, sternal dehiscence and pain [1]. Registries show that the rate of conventional sternotomy for AVR remains far more common compared to minimally invasive approaches [4]. This may reflect two factors: (1) many trials have demonstrated clinical equipoise between the use of conventional sternotomy and mini-access procedures for isolated AVR, including similar rates of survival, functional class echocardiographic outcomes when similar prostheses are used [5, 6]. There have been no randomised studies comparing the additive effect of mini-AVR and the use of sutureless valves in comparable cohorts using the same prosthesis design. This study aims to provide a comparative analysis of the Perceval valve comparing median sternotomy (MS) with mini-sternotomy (MIS)
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