Mini-invasive Approach In Aortic Valve Replacement Results In Decreased Transfusional Requirement

Abstract

Objective: Aortic Valve Replacement (AVR) is the most frequent valve surgery. Classically, it performed through complete sternotomy (CS). Recently, there is growing interest in minimally invasive approaches. Our aim is to compare both approaches in AVR surgery. Methods: We performed a retrospective analysis. Patients who underwent AVR between 2015-2017 were included. We excluded patients with previous cardiac surgery or combined procedures. The two approaches were: CS and Mini-Sternotomy (MS) performed by J type upper incision. The outcomes were: Extracorporeal Circulation Time (ECT), Cross Clamping Time (CCT), Mechanical Venitilation Time (MVT), Transfusion Requirement (TR), Hospital Stay (HS) and Operative Mortality (OM). The variables are expressed in percentages and mean ± standard deviation. For the comparison between groups Student’s T test was used for continuous variables and Chi2 for dichotomous variables, Alpha = 5%. Results: Ninety five patients were included in 3 years. Fifty five (58%) patients underwent CS and 40 (42%) MS. In 2015, 91% CS and 9% MS, 2016 50% CS and 50% MS, 2017 23% CS and 77% MS. The ECT was 85 ± 26min CS and 104 ± 26 MS (p = 0.003), CCT 60 ± 24min CS and 69 ± 16min MS (p = 0.037), MVT 11.7 ± 5.7hs CS and 11.5 ± 21hs MS (NS), TR 3.2 ± 1.9vol in CS and 2.2 ± 1.2vol MS (p = 0.036), HS 8.3 ± 4.4 days in CS and 8.6 ± 8.0 days MS (NS), OM 2/55 CS, 1/40 MS (NS). Conclusions: We present the results of AVR at our institution in the last three years. The use of MS has increased. MS requires higher ECT and CCT. However, this doesn´t imply higher HS, MVT or OM. The MS determines a significant reduction of TR. The minimally invasive approach in AVR constitutes a viable option reducing the transfusional burden.