Mejora de la morbilidad postoperatoria en recambio valvular aórtico aislado con miniesternotomía: estudio pareado por puntuación de propensión

Abstract

BackgroundMinimally invasive aortic valve surgery using the upper mini-sternotomy is becoming more popular in our ¿country?, due to its advantages over conventional median sternotomy. An analysis is presented on the outcomes in our centre for the two years after the implementation of the technique in November 2013. MethodsAn observational analytical retrospective study was conducted on 92 consecutive patients who underwent isolated aortic valve replacement due to severe aortic stenosis after November 2013. Propensity score matching with “nearest neighbour matching” protocol was performed to obtain two groups of 40 patients (mini-sternotomy group and conventional group) for comparison (Primary combined end-point of 6 major adverse cardiac and cerebrovascular events, and secondary end-points such as cardiopulmonary bypass and cross-clamp times, intubation time, bleeding in first 24hours, transfusions, and survival). ResultsMedian cardiopulmonary bypass and cross-clamp times were 15 and 10minutes longer in the mini-sternotomy group (89 [75–110] and 74 [64–90] versus conventional group 65 [55–73] and 55 [47–63] minutes, respectively, P<.001). The mini-sternotomy group had less major complications events (12.5% versus 30% conventional group, p=.05, Odds Ratio 0.32; 95% Confidence Interval; 0.09 -0.93), bleeding in 24hours (304±150ml vs. 506±300ml conventional, p<.001) and transfusion requirements (0.8±0.2 vs. 1.6±0.3 packed red blood cells per patient p=.04). No differences were found in intubation time, hospital stay, mortality, or survival. ConclusionsIsolated aortic valve replacement using mini-sternotomy shows a reduction in morbidity and mortality, so we recommend its use instead of conventional surgery, whenever possible. Further clinical trials are needed to confirm these data.