Minimally Invasive Aortic Valve Replacement Research Articles

Minimal learning curve for minimally invasive aortic valve replacement.

Minimally invasive aortic valve replacement (MiAVR) is an established technique for surgical aortic valve replacement (AVR). Although MiAVR was first described in 1993 and has shown good results compared to full sternotomy AVR (FSAVR) only a minority of patients undergo MiAVR. We recently started using MiAVR via an upper hemisternotomy. We aimed to examine the early results of our initial experience with this technique. We compared 55 MiAVR to a historical cohort of 142 isolated FSAVR (12.2016-12.2022). The primary outcome was in-hospital mortality. Secondary outcomes included cardiopulmonary bypass (CPB) and cross clamp times, blood product intake, in hospital morbidity, and length of ICU and hospital stay. There was no significant difference in preoperative characteristics, including age, laboratory values and co-morbidities. There was no significant difference between the groups regarding in-hospital mortality (FSAVR 3.52% vs MiAVR 1.82%). There was no significant difference in CPB time (FSAVR 103.5 min [IQR 82-119.5] vs MiAVR 107 min [92.5-120]), aortic cross-clamp time (FSAVR 81 min [66-92] vs MiAVR 90 min [73-99]), and valve size (FSAVR 23 [21-25] vs MiAVR 23 [21-25]). The incidence of intraoperative blood products transfusion was significantly lower in the MiAVR group (10.91%) compared to the FSAVR group (25.35%, P=0.03). Our findings further establish the possibility of reducing invasiveness of AVR without compromising patient safety and clinical outcomes. This is true even in the learning curve period and without requiring any significant change in the operative technique and dedicated equipment.

Outcomes of Minimally Invasive Aortic Valve Replacement in Obese Patients: A Propensity-Matched Study.

Obese patients are at risk of complications after cardiac surgery. The aim of this study is to investigate safety and efficacy of a minimally invasive approach via upper sternotomy in this setting. We retrospectively reviewed 203 obese patients who underwent isolated, elective aortic valve replacement between January 2014 and January 2023 - 106 with minimally invasive aortic valve replacement (MIAVR) and 97 with conventional aortic valve replacement (CAVR). To account for baseline differences, a propensity-matching analysis was performed obtaining two balanced groups of 91 patients each. The 30-day mortality rate was comparable between groups (1.1% MIAVR vs. 0% CAVR, P=0.99). MIAVR patients had faster extubation than CAVR patients (6 ± 2 vs. 9 ± 2 hours, P<0.01). Continuous positive airway pressure therapy was less common in the MIAVR than in the CAVR group (3.3% vs. 13.2%, P=0.03). Other postoperative complications did not differ significantly. Intensive care unit stay (1.8 ± 1.2 vs. 3.2 ± 1.4 days, P<0.01), but not hospital stay (6.7 ± 2.1 vs. 7.2 ± 1.9 days, P=0.09), was shorter for MIAVR than for CAVR patients. Follow-up survival was comparable (logrank P-value = 0.58). MIAVR via upper sternotomy has been shown to be a safe and effective option for obese patients. Respiratory outcome was promising with shorter mechanical ventilation time and reduced need for post-extubation support. The length of stay in the intensive care unit was reduced. These advantages might be important for the obese patient to whom minimally invasive surgery should not be denied.

Abstract 11695: Long-Term Clinical Outcomes of Minimally Invasive Aortic Valve Surgery in Patients With Aortic Valve Disease

Introduction: We aim to analyze multicenter long-term clinical outcomes of minimally invasive aortic valve replacement (MI-AVR) in patients with aortic valve disease. Hypothesis: We hypothesize that MI-AVR provides good long-term clinical outcomes in patients undergoing aortic valve surgery. Methods: All consecutive 1,972 patients undergoing MI-AVR with either ministernotomy (n= 986) or right anterior minithoracotomy (RAM, n=986) between 1999 and 2019, were included. Primary outcomes were all-cause mortality and cardiac death. Results: Preoperatively, mean age was 72.1 (±13.7) year-old, and mean STS-PROM risk score was 0.38%. Intraoperatively, mean operative time (min) was 213.97 (± 56.9), while 313 (15.9%) patients were converted to full sternotomy. Postoperatively, 69 (3.5%) patients had prolonged mechanical ventilation (&lt; 24 hours), 59 (3%) patients had re-exploration for bleeding, 10 (0.5%) patients had paravalvular leak (moderate/severe), 22 (1.1%) patients had non-fatal stroke, and 28 (1.4%) patients had non-fatal myocardial infarction. Mean intensive care unit stay was 14.45 (± 10.15) hours, and mean hospital length of stay (LOS) was 7 (± 3.5) days. Thirty-day all-cause mortality occurred in 39 (2%) patients while 30-day cardiac-death occurred in 23 (1.2%) patients. Thirty-day predictors for all-cause mortality included age &lt;75-years, post-operative LOS, peri-operative stroke, and RAM. Mean follow-up time was 10-years. At 20-year follow-up, all-cause death and CV-death incidence were 1156 (60%) and 170 (8.8%) patients, respectively. Valve-related deaths occurred in 33 (1.7%) patients. Long-term predictors for all-cause mortality included age &lt;75-years, chronic kidney failure, mechanical ventilation &lt;12 hours, RAM, and hospital LOS &lt;10 days. Conclusions: MI-AVR is a safe, valid, and reproducible surgical procedure for patients with aortic valve disease. In addition, it provides good long-term outcomes.

Early Outcome of Minimally-Invasive Aortic Valve Replacement through Mini Sternotomy versus Conventional Approach

Early Outcome of Minimally-Invasive Aortic Valve Replacement through Mini Sternotomy versus Conventional Approach

Conventional Versus Minimally Invasive Aortic Valve Replacement Surgery: A Systematic Review, Meta-Analysis, and Meta-Regression.

Objective: To assess the potential benefits of minimally invasive aortic valve replacement (MIAVR) compared with conventional AVR (CAVR) by examining short-term outcomes. Methods: A systematic search identified randomized trials comparing MIAVR with CAVR. To assess study limitations and quality of evidence, we used the Cochrane Risk of Bias tool and GRADE and performed random-effects meta-analysis. We used meta-regression and sensitivity analysis to explore reasons for diversity. Results: Thirteen studies (1,303 patients) were included. For the comparison of MIAVR and CAVR, the risk of bias was judged low or unclear and the quality of evidence ranged from very low to moderate. No significant difference was observed in mortality, stroke, acute kidney failure, infectious outcomes, cardiac events, intubation time, intensive care unit stay, reoperation for bleeding, and blood transfusions. Blood loss (mean difference [MD] = -130.58 mL, 95% confidence interval [CI] = -216.34 to -44.82, I2 = 89%) and hospital stay (MD = -0.93 days, 95% CI = -1.62 to -0.23, I2 = 81%) were lower with MIAVR. There were shorter aortic cross-clamp (MD = 5.99 min, 95% CI = 0.99 to 10.98, I2 = 93%) and cardiopulmonary bypass (CPB) times (MD = 7.75 min, 95% CI = 0.27 to 15.24, I2 = 94%) in the CAVR group. In meta-regression analysis, we found that age was the variable with the greatest influence on heterogeneity. Conclusions: MIAVR seems to be an excellent alternative to CAVR, reducing hospital stay and incidence of hemorrhagic events. Despite significantly greater aortic cross-clamp and CPB times with MIAVR, this did not translate into adverse effects, with no changes in the results found with CAVR.

Ministernotomy for aortic valve replacement improves early recovery and facilitates proper wound healing - forced propensity score matching design with reference full sternotomy.

IntroductionWith the development of less invasive techniques ministernotomy has become an increasingly popular choice for minimally invasive aortic valve replacement (MIAVR). However, a large discrepancy in the published results, often derived from the center’s own experience, intensifies the need for further re-evaluation in order to better define the real impact of the ministernotomy approach on postoperative clinical condition in short- and long-term observation.AimTo assess the safety and efficacy of MIAVR in comparison to a reference full sternotomy AVR (FSAVR).Material and methodsBetween January 2004 and January 2018, 2386 patients underwent isolated surgical aortic valve replacement (AVR) at our institution. 620 patients were treated minimally invasively (MIAVR) and 1766 patients received FSAVR. Forced propensity score 1 : 1 matching and conditional regressive methods were introduced, ensuring valid comparison and correct estimation. Ultimately, 557 well allocated pairs of treated and control patients were included.ResultsIn-hospital mortality was low and comparable (1.26% for MIAVR, 1.62% for FSAVR). No significant differences in terms of serious adverse events were found, although in patients undergoing MIAVR there tended to be lower incidence of neurological complications (OR = 0.72; p = 0.09) and low output syndrome (OR = 0.66; p = 0.13). In addition to a much faster extubation and discharge from the ICU as well as improved blood management, MIAVR significantly reduced the risk of wound complications (OR = 0.31; p < 0.0010).ConclusionsMIAVR is a safe, effective and reproducible procedure providing at least as good results as FSAVR. Nevertheless, it should be especially recommended to obese, diabetic patients with pulmonary and mobility disorders in order to improve their early recovery.

Bundle Branch Re-Entrant Ventricular Tachycardia after Minimal Invasive Cardiac Surgery

Background: Bundle branch re-entrant ventricular tachycardia (BBRVT) is a monomorphic ventricular arrhythmia with wide QRS complexes caused by re-entrant tachycardia between both bundle branches. BBRVT can occur in a variety of cardiac pathologies with His–Purkinje system (HPS) conduction abnormalities such as dilated cardiomyopathy, coronary artery disease, hypertrophic cardiomyopathy, valvular heart disease and even after aortic valve surgery. Case report: A 62-year-old male patient with an ischemic cardiomyopathy and implantable cardioverter defibrillator (ICD) underwent minimal invasive aortic valve replacement (Yil-AVR) and coronary artery bypass graft (CABG). He was remitted a week later because of relapsing sustained ventricular tachycardia (VT). Electrocardiogram showed a wide QRS tachycardia, which was remarkably similar to the patient’s sinus rhythm. Analysis of ICD revealed the presence of BBRVT. Catheter ablation of the right bundle branch (RBB) was performed. He is currently in clinical follow-up and no reoccurrence of VT has been recorded so far. Conclusion: Patients with known cardiomyopathy can develop BBRVT early after cardiac surgery. To our knowledge, this is the first time that BBRVT occurred after Yil-AVR.

Safety and Efficiency of Mini-Sternotomy versus Standard Sternotomy in Open Heart Surgery for Aortic Valve Replacement

Background: For decades, the traditional median sternotomy has been the access of choice in aortic valve surgery; however, numerous researchers have worked to develop less invasive procedures, and the partial upper mini-sternotomy is the most prevalent minimally invasive procedure. Objective: To compare outcomes, in patients who undergo mini-sternotomy, and patients who undergo standard sternotomy, in aortic valve replacement operations. Patients and Methods: This randomized controlled clinical trial study included fifty patients who were admitted to the Zagazig University Hospital, Cardiothoracic Surgery Department in the period between January 2021 to August 2021, Patients were split into two groups, each with 25 patients: Group A had aortic valve surgery by mini-sternotomy, while Group B got aortic valve surgery via traditional surgery. Aortic valve surgery was performed via a conventional median sternotomy in Group B. An ECG was performed to see whether there was any ischemia present, as well as laboratory tests and a chest x-ray. Results: In the present research, there was a significant difference in postoperative outcomes between the mini-sternotomy and complete sternotomy groups in terms of mechanical ventilation and hospital stay. Inotropic support and reopening were not substantially different across groups; however, infection and blood transfusion were strongly linked with the complete group, and neither group had any mortality. Conclusions: Minimally invasive aortic valve replacement, is a safe and effective procedure and is performed with comparable morbidity and mortality to conventional aortic valve replacement (AVR). Minimally invasive aortic valve replacement (MIAVR) results in improved ventilator function, fewer wound infections, shorter hospital stays, and a higher percentage of patients released home early.

SOME INNOVATIVE TECHNOLOGIES FOR THE CORRECTION OF VALVULAR HEART DISEASES. REVIEW

Valve defects or congenital/acquired heart defects are damage to the valve and/or subvalvular structures, which leads to impaired hemodynamics and the development of heart failure. Asymptomatic valvular heart disease is present in 2.5% of the population; with age, this figure rises to 13%. In the absence of permanent treatment, lesions of the heart valves significantly reduce the quality and duration of life. The European Society of Cardiology (ESC) and the American Heart Association (AHA) regularly review the effectiveness of new surgical treatments and reflect their findings in international guidelines. Today, minimally invasive surgery is the most effective and safe way to treat patients with valvular heart disease. The article presents two new methods for the treatment of valvular heart disease. Transapical mitral valve repair on a beating heart with neochord implantation (TOP-MINI) is a new MVP option that has been approved for patients with severe mitral regurgitation due to prolapse of the leaflet (s) or chord (grades 2-4). The new procedure with the NeoChord DS1000 device results in a significant reduction in mitral regurgitation and in reverse remodeling of the left ventricle and left atrium after 6 months of follow-up. Also reviewed is Minimally Invasive Aortic Valve Replacement (MAVR), which has been shown to be beneficial in improving patient satisfaction by minimizing pain and earlier recovery. Sutureless valves are preferred over traditional aortic valve replacement (AVR) due to the reduced operation time and the need for blood transfusion. The Perceval valve (Sorin, Sallugia, Italy) is a self-expanding bovine pericardial prosthesis placed in a nitinol stent designed to facilitate aortic valve implantation. A systematic review and meta-analysis demonstrated that the early clinical and hemodynamic characteristics of the Perceval valve are satisfactory and comparable to those of conventional AVRs. This literature review was carried out in accordance with the PRISM statement. The databases searched in this review included Pubmed, Web of Science, Scopus and Cochrane databases for systematic reviews

Minimal Invasive Aortic Valve Replacement by Upper Ministernotomy Approach in Comparison to The Conventional Full Median Sternotomy Approach

Minimal Invasive Aortic Valve Replacement by Upper Ministernotomy Approach in Comparison to The Conventional Full Median Sternotomy Approach

Influence of cardiopulmonary bypass set-up and management on clinical outcomes after minimally invasive aortic valve surgery.

Minimally invasive aortic valve replacement (MIAVR) requires changes in cannulation strategy and cardiopulmonary bypass (CPB) management when compared to the conventional approach (CAVR). We aimed at evaluating if these differences could influence perfusion-related quality parameters and impair postoperative outcomes. Overall, 339 consecutive patients underwent MIAVR or CAVR between 2014 and 2020 and were analyzed retrospectively. To account for baseline differences, a propensity-matching analysis was performed, obtaining two groups of 97 patients each. MIAVR group had longer CPB time [107 (95-120) vs 95 (86-105) min, p = .003] than CAVR group. Of note, average pump flow rate index [2.4 (2.2-2.5) vs 2.7 (2.4-2.8) l/min/m2, p = .004] was lower in the MIAVR group. Mean arterial pressure was 73 = 9 mmHg vs 62 = 11 mmHg for the MIAVR and CAVR group, respectively (p < .001). Cell-salvaged blood was most commonly used in the MIAVR group (25.8% vs 11.3%, p = .02). Finally, CPB temperature was 32.8°C (32.1-34.8) for MIAVR group vs 34.9°C (33.2-36.1) for the CAVR group (p = .02). Postoperative complications were similar between groups. In conclusion, despite differences in CPB parameters in patients undergoing CAVR and MIAVR, the incidences of adverse outcomes were similar. However, compared to CAVR, MIAVR was associated with shorter durations of mechanical ventilation and hospital stay as well as less transfusion of blood products.

Minimal Invasive Aortic Valve Replacement Through Right Mini_Thoracotomy Versus Conventional Approach In The Egypt

Background: Full median sternotomy was established a long time ago as the standard approach for all varieties of heart surgery. Although that, it may cause significant surgical trauma and morbidity, so minimally invasive cardiac surgery for aortic valve replacement via partial sternotomy, para-sternal approach and anterior mini-thoracotomy is used trying to improve the outcome . Objective: to check the outcome of minimally invasive aortic valve surgery through a right mini-thoracotomy, and its rule in minimizing the surgical access, achieving better wound appearance, decreasing post-operative discomfort and better postoperative recovery with the same safety and results like conventional surgery . Methods: our study was performed in the Armed Forces Hospitals El Maddi& El Galaa and kobry elkobba, Egypt. Between January 2015 to March 2017, sixty patients were diagnosed with AVD requiring aortic valve surgery were randomly selected, of them Thirty patients had aortic valve surgery through full median sternotomy with aorto-right atrial cannulation and the other thirty patients had right mini-thoracotomy with femoral cannulation . Results# Minimally invasive aortic valve replacement (MIAVR) was associated with reduced morbidity and mortality, where there was a safer approach in case of re-operation, better cosmetic outcome, less bleeding post-operative, lower number of blood products usage, less intensive care unit and hospital stays, decreased time until return to full activity and avoiding the incidence of sternal wound infection. That good results were also achievable in high-risk patients . Conclusion: Minimal Invasive Aortic Valve Replacement Through Right Mini-thoracotomy is an acceptable alternative to Full median sternotomy, has reduced morbidity and potential mortality and good clinical outcome, with two concerns which are the operative cost and the relatively long bypass and cross clamp time which are related to the learning curve of the surgeons

Minimally-invasive versus transcatheter aortic valve implantation: systematic review with meta-analysis of propensity-matched studies.

BackgroundMinimally invasive aortic valve replacement (MiAVR) and transcatheter aortic valve implantation (TAVI) provide aortic valve replacement (AVR) by less invasive methods than conventional surgical AVR, by avoiding complete sternotomy. This study directly compares and analyses the available evidence for early outcomes between these two AVR methods.MethodsElectronic databases were searched from inception until August 2019 for studies comparing MiAVR to TAVI, according to predefined search criteria. Propensity-matched studies with sufficient data were included in a meta-analysis.ResultsEight studies with 9,744 patients were included in the quantitative analysis. Analysis of risk-matched patients showed no difference in early mortality (RR 0.76, 95% CI, 0.37–1.54, P=0.44). MiAVR had a signal towards lower rate of postoperative stroke, although this did not reach statistical significance (OR 0.42, 95% CI, 0.13–1.29, P=0.13). MiAVR had significantly lower rates of new pacemaker (PPM) requirement (OR 0.29, 95% CI, 0.16–0.52, P<0.0001) and postoperative aortic insufficiency (AI) or paravalvular leak (PVL) (OR 0.05, 95% CI, 0.01–0.20, P<0.0001) compared to TAVI, (OR 0.42, 95% CI, 0.13–1.29, P=0.13), while acute kidney injury (AKI) was higher in MiAVR compared to TAVI (11.1% vs. 5.2%, OR 2.28, 95% CI, 1.25–4.16, P=0.007).ConclusionsIn patients of equivalent surgical risk scores, MiAVR may be performed with lower rates of postoperative PPM requirement and AI/PVL, higher rates of AKI and no statistical difference in postoperative stroke or short-term mortality, compared to TAVI. Further prospective trials are needed to validate these results.

Minimally invasive aortic valve surgery.

Since their introduction, it has been demonstrated that minimally invasive aortic valve replacement (MIAVR) approaches are safe and effective for the treatment of aortic valve diseases. To date, the main advantage of these approaches is represented by the reduced surgical trauma, with a subsequent reduced complication rate and faster recovery. This makes such approaches an appealing choice also for frail patients [obese, aged, chronic obstructive pulmonary disease (COPD)]. The standardization of the minimally invasive techniques, together with the implementation of preoperative workup and anesthesiological intra- and post-operative care, led to an amelioration of surgical results and reduction of surgical times. Moreover, the improvement of surgical technology and the introduction of new devices such as sutureless and rapid deployment (SURD) valves, has helped the achievement of comparable results to traditional surgery. However, transcatheter technologies are nowadays more and more important in the treatment of aortic valve disease, also in low risk patients. For this reason surgeons should put new efforts for further reducing the surgical trauma in the future, even taking inspiration from other disciplines. In this review, we aim to present a review of literature evidences regarding minimally invasive treatment of aortic diseases, also reflecting our personal experience with MIAVR techniques. This review could represent a tool for a well-structured patient assessment and preoperative planning, in order to safely carrying out an MIAVR procedure with satisfactory outcomes.

Step-by-Step Minimally Invasive Aortic Valve Replacement: the RAT Approach.

In the growing era of transcatheter aortic valve implantation, it is crucial to develop minimally invasive surgical techniques. These methods enable easier recovery from surgical trauma, especially in elderly and frail patients. Minimally invasive aortic valve replacement (MIAVR) is frequently performed via upper hemisternotomy. We describe MIAVR via right anterior thoracotomy, which is associated with less trauma, rapid mobilization, lower blood transfusion rates, and lower risk of postoperative wound infections. As minimally invasive procedures tend to take longer operative times, we suggest using rapid-deployment valve prostheses to overcome this limitation. This description focuses on the technical aspects and preoperative assessment.

Minimally Invasive Aortic Valve Surgery in Octogenarians: Reliable Option or Fallback Solution?

Aortic valve disease is more and more common in western countries. While percutaneous approaches should be preferred in older adults, previous reports have shown good outcomes after surgery. Moreover, advantages of minimally invasive approaches may be valuable for octogenarians. We sought to compare outcomes of conventional aortic valve replacement (CAVR) versus minimally invasive aortic valve replacement (MIAVR) in octogenarians. We retrospectively collected data of 75 consecutive octogenarians who underwent primary, elective, isolated aortic valve surgery through conventional approach (41 patients, group CAVR) or partial upper sternotomy (34 patients, group MIAVR). Mean age was 81.9 ± 0.9 and 82.3 ± 1.1 years in CAVR and MIAVR patients, respectively (P = 0.09). MIAVR patients had lower 24-hour chest drain output (353.4 ± 207.1 vs 501.7 ± 229.9 mL, P < 0.01), shorter mechanical ventilation (9.6 ± 2.4 vs 11.3 ± 2.3 hours, P < 0.01), lower need for blood transfusions (35.3% vs 63.4%, P = 0.02), and shorter hospital stay (6.8 ± 1.6 vs 8.3 ± 4.3 days, P < 0.01). Thirty-day mortality was zero in both groups. Survival at 1, 3, and 5 years was 89.9%, 80%, and 47%, respectively, in the CAVR group, and 93.2%, 82.4%, and 61.8% in the MIAVR group, with no statistically significant differences (log-rank test, P = 0.35). Aortic valve surgery in older patients provided excellent results, as long as appropriate candidates were selected. MIAVR was associated with shorter mechanical ventilation, reduced blood transfusions, and reduced hospitalization length, without affecting perioperative complications or mid-term survival.

The benefit of fibrosa layer stripping technique during minimally invasive aortic valve replacement for calcified aortic valve stenosis-A randomized controlled trial.

Fibrosa layer stripping (FLS) technique is a new approach to remove the calcified aortic valve. In this study, we aimed to assess the effectiveness of the FLS technique by comparing it with the conventional technique in minimally invasive aortic valve replacement (MIAVR). A prospective, single-center, randomized controlled trial was conducted at Beijing Anzhen Hospital. Seventy patients diagnosed with severe calcific aortic stenosis were randomly assigned to undergo FLS (n = 35) or conventional (n = 35) technique to debride calcified aortic valve. Preoperative profile, procedural parameters, and postoperative outcomes were analyzed. No significant difference was observed in the preoperative profile between the two groups. Compared with the conventional technique, the FLS technique had a significantly higher indexed effective orifice area and lower mean gradient. Moreover, the FLS technique was associated with significantly reduced aortic cross-clamp time (41 [38-44] vs. 56 [51-60] min, p < .001), cardiopulmonary bypass (CPB) time (63 [56-69] vs. 81 [75-84] min, p < .001), and operative time (148 [141-156] vs. 173 [169-180] min, p < .001). Lastly, the length of intensive care unit stay (1.2 ± 0.4 vs. 1.5 ± 0.8 days, p = .041) and hospital stay (5.3 ± 0.6 vs. 6.0 ± 1.4 days, p = .020) was significantly reduced in the FLS group compared with those in the conventional group. FLS technique is effective in removing calcified tissue during MIAVR and is associated with shorter cross-clamp time and CPB time, and better hemodynamic performance than the conventional technique.

Minimally-invasive parasternal aortic valve replacement-A slow learning curve towards improved outcomes.

We report our starting experience with parasternal minimally-invasive aortic valve replacement. From 7/14 to 8/18, 192 received classic aortic valve surgery using a 5 cm parasternal incision and percutaneous groin cannulation. Patients were selected based on anatomic feasibility judged by preoperative computed tomography-scan. Except for porcelain aorta, left-sided aortic location, or endocarditic abscess, there were no exclusions. Patients were divided into two groups (first and second half of experience). Demographics were equal. Patients' mean ejection fraction was 59%, with preoperative stroke (12%), severe chronic obstructive pulmonary disorder(11%), and endocarditis (2%). All cases were elective or urgent. The Euroscore II was 3.37 ± 3.31 in the first and 3.68 ± 3.97 in the second group (n.s.). Biological prostheses were implanted in 90%. Operating times in the first group were just under 3 hours, with bypass times of 129 ± 32 minutes and clamp times of 77 ± 20 minutes. In the second group, these times changed only minimally. There were three conversions to sternotomy in the first, but only one in the second group. Similarly, three patients died in the first and one in the second group. There were fewer complications in the second group regarding revision for bleeding (7 vs 1%), stroke (4 vs0%) dialysis (3 vs1%), and pericardial effusions (3 vs1%). The O/E ratio dropped from 0.93 to 0.28. Parasternal minimally-invasive aortic valve replacement is a feasible technique associated with a slow learning curve but the potential to achieve improved outcomes. Considering the transcatheter alternatives, the relative risk reduction may be worth investigating in future trials.

Comparative study between standard aortic valve replacement and ministernotomy aortic valve replacement

Objectives The aim of this study is to evaluate the outcome of the recalled upper minimally invasive aortic valve replacement (MIAVR) J-shaped technique and full standard median sternotomy techniques aortic valve replacement (AVR). Background Over the past 20 years, MIAVR has evolved into a safe, well-tolerated, and efficient surgical treatment option for aortic valve disease. It has been shown to reduce postoperative morbidity, providing faster recovery and rehabilitation, shorter hospital stays, and better cosmetic results, as it reduces the incidences of wound infection owing to small incision length, especially in our diabetic fatty Egyptian female patients. Patients and methods Between September 2017 and March 2019, this study included 50 patients with isolated aortic valve disease. A total of 25 patients (group A) underwent (MIAVR) J-shaped technique and 25 patients (group B) underwent standard AVR, and they were compared with each other. Results In operative data, there were highly significant differences between both groups regarding aortic cross-clamp time, total bypass time, and total operative time (P Conclusion MIAVR is a feasible procedure despite the narrow operative field that induced long operative times. It is safe with minimal postoperative morbidities, early rehabilitation, and less postoperative pain. Moreover, MIAVR provided cosmetically better wound results, which was immensely satisfying to the patients.

Minimally Invasive Aortic Valve Replacement with Sutureless Valves: Results From an International Prospective Registry

To report the early and mid-term results of patients who underwent minimally invasive aortic valve replacement (MI-AVR) with a sutureless prosthesis from an international prospective registry. Between March 2011 and September 2018, among 957 patients included in the prospective observational SURE-AVR (Sorin Universal REgistry on Aortic Valve Replacement) registry, 480 patients underwent MI-AVR with self-expandable Perceval aortic bioprosthesis (LivaNova PLC, London, UK) in 29 international institutions through either minithoracotomy (n = 266) or ministernotomy (n = 214). Postoperative, follow-up, and echocardiographic outcomes were analyzed for all patients. Patient age was 76.1 ± 7.1 years; 64.4% were female. Median EuroSCORE I was 7.9% (interquartile range [IQR], 4.8 to 10.9). Median cardiopulmonary bypass and cross-clamp times were 81 minutes (IQR 64 to 100) and 51 minutes (IQR 40 to 63). First successful implantation was achieved in 97.9% of cases. Two in-hospital deaths occurred, 1 for noncardiovascular causes and 1 following a disabling stroke. In the early (≤30 days) period, stroke rate was 1.4%. Three early explants were reported: 2 due to nonstructural valve dysfunction (NSVD) and 1 for malpositioning. One mild and 1 moderate paravalvular leak were reported. In 16 patients (3.3%) pacemaker implantation was needed. Mean follow-up was 2.4 years (maximum = 7 years). During follow-up 5 explants were reported, 3 due to endocarditis and 2 due to NSVD. Follow-up stroke rate was 2.5%. Three structural valve deteriorations not requiring reintervention were reported. Five-year survival was 91.45%. In this large prospective international registry, MI-AVR with Perceval valve confirmed to be safe, reproducible, and effective in an intermediate-risk population, providing excellent clinical recovery both in early and mid-term follow-up.