RF48 MINIMALLY INVASIVE APPROACHES VIA RIGHT ANTERIOR MINITHORACOTOMY OR UPPER HEMI-STERNOTOMY FOR ISOLATED AORTIC VALVE REOPERATION: SINGLE CENTER EXPERIENCE

Abstract

Abstract Objective: Aortic valve replacement (AVR) after previous cardiac surgery is associated with an increased risk. This study compare the outcome after AVR through upper “J” ministernotomy or minithoracotomy versus standard full sternotomy in redo operation. Methods: We retrospectively reviewed 221 patients treated between October 2007 and November 2017; 91 (41%) had minimally invasive approach via right minithoracotomy (n°=11) or upper “J” ministernotomy (n°=80) and the remainings 130 (59%) had full sternotomy. Results: Mean age was 69.6 ± 12.0 years in minimally invasive group and 69.02 ± 13.0 for the full sternotomy group (p = 0.46).No differences in terms of body mass index (p = 0.70), left ventricular ejection fraction (p = 0.58) and EURO score (p = 0.32) between two groups. Intraoperative data and postoperative outcomes have been analyzed. Mean cardiopulmonary bypass time and cross-clamp time were respectively 68.6 ± 23.9 min and 53.6 ± 20.9 in the minimally invasive group and 83.9 ± 41.7 min and 61.15 ± 26.7 in the full sternotomy group (p < 0,005); 64% of patients in minimally invasive group and 66% in sternotomy group underwent blood transfusions (p = 0.72). Post operative ventilation time was lower in patients treated with minimally invasive technique: median was 6 versus 11 hours (p = 0.93). Median intensive care unit stay for patients operated through a mini-invasive approach vs full sternotomy was very similar (2 vs 1,93 days; p = 0.90). In-hospital mortality in the minimally invasive group was 3,2% (3/91) compared to 4.6% for the full sternotomy group (6/130) (p = 0.70). Conclusions: Minimally invasive aortic valve reoperation proved to be as safe as standard procedure in terms of hospital morbidity and mortality rates.