Minimally Invasive versus Full Sternotomy SAVR in the Era of TAVR: An Institutional Review.

Tyler W Wilson,Joshua J Horns,Sara J Pereira,Jason P Glotzbach,Hiroshi Kagawa,Vikas Sharma,Stephen H Mckellar,Matthew L Goodwin,Craig H Selzman

doi:10.3390/jcm11030547

Tyler W Wilson, Joshua J Horns + Show 7 more

Open Access

https://doi.org/10.3390/jcm11030547

Copy DOI

Abstract

In the era of advancing transcatheter aortic valve replacement (TAVR) technology, traditional open surgery remains a valuable intervention for patients who are not TAVR candidates. We sought to compare perioperative variables and postoperative outcomes of minimally invasive and full sternotomy surgical aortic valve replacement (SAVR) at a single institution. A retrospective analysis of 113 patients who underwent isolated SAVR via full sternotomy or upper hemi-sternotomy between January 2015 and December 2019 at the University of Utah Hospital was performed. Preoperative comorbidities and demographic information were not different among groups, with the exception of diabetes, which was significantly more common in the full sternotomy group (p = 0.01). Median procedure length was numerically shorter in the minimally invasive group but was not significant following the Bonferroni correction (p = 0.047). Other perioperative variables were not significantly different. The two groups showed no difference in the incidence of postoperative adverse events (p = 0.879). As such, minimally invasive SAVR via hemi-sternotomy remains a safe and effective alternative to full sternotomy for patients who meet the criteria for aortic valve replacement.

Highlights

With increased advancements in transcatheter aortic valve replacement (TAVR) technology, its implementation is continually expanding as a treatment for aortic valve pathology
As treatment for aortic valve disease moves toward less invasive approaches with TAVR, it is important to continue to assess the outcomes of less invasive surgical approaches, which remain relevant to patients for whom TAVR is not an option
We considered nine outcomes that were each modeled against surgery type using mixed-effect regression: procedure length, cardiac bypass time, cross-clamp time, aortic gradient, length of stay, aortic reintervention, atrial fibrillation, and postoperative events

Summary

Introduction

With increased advancements in transcatheter aortic valve replacement (TAVR) technology, its implementation is continually expanding as a treatment for aortic valve pathology. Traditional open surgical aortic valve replacement (SAVR) remains an important therapeutic modality for patients who have either a history of bicuspid aortic valve, mixed pathology, or large annuli and have low-to-intermediate surgical risk [3,4]. Full median sternotomy for SAVR has been the routine approach since the 1960s, demonstrating consistently low morbidity at experienced centers [5]. Despite these consistent outcomes, minimally invasive techniques for SAVR have gained acceptance in the cardiac surgical community as a safe and comparable alternative to conventional methods since their introduction in the late 1990s [6]. As treatment for aortic valve disease moves toward less invasive approaches with TAVR, it is important to continue to assess the outcomes of less invasive surgical approaches, which remain relevant to patients for whom TAVR is not an option

Objectives

Methods

Discussion

Conclusion