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Mohamed MA, Ding S, Ali Shah SZ, Li R, Dirie NI, Cheng C, Wei X. Comparative Evaluation of the Incidence of Postoperative Pulmonary Complications After Minimally Invasive Valve Surgery vs. Full Sternotomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Propensity Score-Matched Studies. Front Cardiovasc Med 2021; 8:724178. [PMID: 34497838 PMCID: PMC8419439 DOI: 10.3389/fcvm.2021.724178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/27/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Postoperative pulmonary complications remain a leading cause of increased morbidity, mortality, longer hospital stays, and increased costs after cardiac surgery; therefore, our study aims to analyze whether minimally invasive valve surgery (MIVS) for both aortic and mitral valves can improve pulmonary function and reduce the incidence of postoperative pulmonary complications when compared with the full median sternotomy (FS) approach. Methods: A comprehensive systematic literature research was performed for studies comparing MIVS and FS up to February 2021. Randomized controlled trials (RCTs) and propensity score-matching (PSM) studies comparing early respiratory function and pulmonary complications after MIVS and FS were extracted and analyzed. Secondary outcomes included intra- and postoperative outcomes. Results: A total of 10,194 patients from 30 studies (6 RCTs and 24 PSM studies) were analyzed. Early mortality differed significantly between the groups (MIVS 1.2 vs. FS 1.9%; p = 0.005). Compared with FS, MIVS significantly lowered the incidence of postoperative pulmonary complications (odds ratio 0.79, 95% confidence interval [0.67, 0.93]; p = 0.004) and improved early postoperative respiratory function status (mean difference -24.83 [-29.90, -19.76]; p < 0.00001). Blood transfusion amount was significantly lower after MIVS (p < 0.02), whereas cardiopulmonary bypass time and aortic cross-clamp time were significantly longer after MIVS (p < 0.00001). Conclusions: Our study showed that minimally invasive valve surgery decreases the incidence of postoperative pulmonary complications and improves postoperative respiratory function status.
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Affiliation(s)
- Mohamed Abdulkadir Mohamed
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuai Ding
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sayed Zulfiqar Ali Shah
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Li
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Najib Isse Dirie
- Division of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cai Cheng
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Wei
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ghoreishi M, Thourani VH, Badhwar V, Massad M, Svensson L, Taylor BS, Pasrija C, Gammie JS, Jacobs JP, Cox M, Grau-Sepulveda M, Brennan M, Griffith BP, Milliken JC, Abdelhady K, Kon Z. Less-Invasive Aortic Valve Replacement: Trends and Outcomes From The Society of Thoracic Surgeons Database. Ann Thorac Surg 2021; 111:1216-1223. [DOI: 10.1016/j.athoracsur.2020.06.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 10/23/2022]
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3
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(Current trend in minimally invasive aortic valve surgery in the Czech Republic). COR ET VASA 2020. [DOI: 10.33678/cor.2020.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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4
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Seguel E, Beurtherert S, Herzberg D, Gutiérrez L, Cofré S, Labra A. Implante experimental de una bomba de asistencia circulatoria de flujo continuo en posición valvular aórtica. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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5
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Klein P, Klop IDG, Kloppenburg GLT, van Putte BP. Planning for minimally invasive aortic valve replacement: key steps for patient assessment. Eur J Cardiothorac Surg 2019; 53:ii3-ii8. [PMID: 29718230 DOI: 10.1093/ejcts/ezy086] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 02/06/2018] [Indexed: 12/12/2022] Open
Abstract
Minimally invasive aortic valve replacement (MIAVR) has proved to be a safe approach for the treatment of aortic valve stenosis and/or insufficiency and is associated with a number of additional benefits for patients. This includes reduced blood loss, reduced transfusion requirements, reduced length of hospital stay and improved aesthetic appearance. As all types of minimally invasive surgery rely on optimizing exposure within a more limited field of view, a thorough preoperative assessment of patients is important to identify and address potential exposure problems. MIAVR through an upper hemisternotomy is considered feasible in almost every patient, but various clinical conditions or anatomical variations can complicate the procedure and may impact on the postoperative outcome. MIAVR through an anterior right thoracotomy requires suitable anatomy, and this should be evaluated preoperatively through a computed tomography or magnetic resonance imaging scan. In this review, we aimed to present an overview of the current literature and to reflect on our personal experiences with MIAVR techniques. This should provide an aid-especially to surgeons wanting to start or have little experience with MIAVR-for a structured preoperative patient assessment and planning to increase the chance of a safe procedure with a good outcome.
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Affiliation(s)
- Patrick Klein
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Idserd D G Klop
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | | | - Bart P van Putte
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
- Department of Cardiothoracic Surgery, AMC Heart Centre, Academic Medical Center, Amsterdam, Netherlands
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Garrido JM, Cánovas S, Cuenca J, Barquero JM, Silva J, Araji O, Gómez MÁ, Castellá M, Hornero F, Centella T. Abordaje integral de la valvulopatía aórtica. Implante transcatéter de válvula aórtica. Posición y recomendaciones de la Sociedad Española de Cirugía Torácica y Cardiovascular. CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2018.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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7
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Shimura T, Yamamoto M, Kagase A, Kodama A, Kano S, Koyama Y, Tada N, Takagi K, Araki M, Yamanaka F, Shirai S, Watanabe Y, Hayashida K. The incidence, predictive factors and prognosis of acute pulmonary complications after transcatheter aortic valve implantation. Interact Cardiovasc Thorac Surg 2017; 25:191-197. [PMID: 28453816 DOI: 10.1093/icvts/ivx075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 01/30/2017] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Although acute pulmonary complications (APCs), such as the exacerbation of pulmonary disease (PD) or a newly developed pulmonary event, are thought to be catastrophic after invasive therapy, little is known about the occurrence of APCs after transcatheter aortic valve implantation (TAVI). This study aims to clarify the incidence, predictive factors and impact of APCs on prognosis after TAVI. METHODS We identified 749 patients who underwent TAVI, using data from the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) Japanese multicentre registry. APCs were defined as exacerbation of a comorbidity or newly developed PD during hospitalization. Patients were divided into 2 groups: an APC group (1.5%, 11/749) and a non-APC group (98.5%, 738/749). Clinical and prognostic outcomes were compared, and predictive factors for APCs were assessed. RESULTS Procedure-related death did not differ between the groups (0.4% vs 0.0%, P = 1.00), although 30-day mortality was significantly higher in the APC group than in the non-APC group (27.3% vs 1.6%, P = 0.001) and the difference in cumulative 1-year mortality increased further (72.7% vs 8.6%, log-rank test: P < 0.001). In particular, concomitant PD and transapical (TA) approach were identified as predictors of APCs after TAVI [univariable odds ratio (uOR) = 24.2, 95% confidence interval (CI) = 3.08-189.9, P = 0.002; uOR = 3.69, 95% CI = 1.11-12.3, P = 0.033, respectively]. CONCLUSIONS Although rare, the occurrence of APCs after TAVI was associated with extremely poor prognosis. Patients undergoing TAVI with concomitant PD and/or TA require careful consideration to avoid the risk of APCs.
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Affiliation(s)
- Tetsuro Shimura
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Ai Kagase
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Atsuko Kodama
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Seiji Kano
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Yutaka Koyama
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | - Kensuke Takagi
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Fudulu D, Lewis H, Benedetto U, Caputo M, Angelini G, Vohra HA. Minimally invasive aortic valve replacement in high risk patient groups. J Thorac Dis 2017; 9:1672-1696. [PMID: 28740685 DOI: 10.21037/jtd.2017.05.21] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Minimally invasive aortic valve replacement (AVR) aims to preserve the sternal integrity and improve postoperative outcomes. In low risk patients, this technique can be achieved with comparable mortality to the conventional approach and there is evidence of possible reduction in intensive care and hospital length of stay, transfusion requirement, renal dysfunction, improved respiratory function and increased patient satisfaction. In this review, we aim to asses if these benefits can be transferred to the high risk patient groups. We therefore, discuss the available evidence for the following high risk groups: elderly patients, re-operative surgery, poor lung function, pulmonary hypertension, obesity, concomitant procedures and high risk score cohorts.
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Affiliation(s)
- Daniel Fudulu
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
| | - Harriet Lewis
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
| | - Umberto Benedetto
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
| | - Massimo Caputo
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
| | - Gianni Angelini
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
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9
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Potential Pitfalls of Reporting and Bias in Observational Studies With Propensity Score Analysis Assessing a Surgical Procedure. Ann Surg 2017; 265:901-909. [DOI: 10.1097/sla.0000000000001797] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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10
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Outcomes of a Less-Invasive Approach for Proximal Aortic Operations. Ann Thorac Surg 2017; 103:533-540. [DOI: 10.1016/j.athoracsur.2016.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/23/2016] [Accepted: 06/06/2016] [Indexed: 11/23/2022]
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11
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Stoliński J, Plicner D, Gawęda B, Musiał R, Fijorek K, Wąsowicz M, Andres J, Kapelak B. Function of the Respiratory System in Elderly Patients After Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2016; 30:1244-53. [PMID: 27178101 DOI: 10.1053/j.jvca.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the function of the respiratory system after aortic valve replacement through median sternotomy (AVR) or the minimally invasive right anterior minithoracotomy (RAT-AVR) approach among elderly (aged≥75 years) patients. DESIGN Observational cohort study. SETTINGS University hospital. PARTICIPANTS The study included 65 elderly patients scheduled for RAT-AVR and 82 for standard AVR. INTERVENTIONS Pulmonary function tests (PFT) were performed preoperatively, 1 week, 1 month, and 3 months after surgery. In addition, respiratory complications were analyzed. MEASUREMENTS AND MAIN RESULTS Respiratory complications occurred in 12.3% of patients in the RAT-AVR group and 18.3% of patients in the AVR group (p = 0.445). Mechanical ventilation time in the intensive care unit was 7.7±3.6 hours for RAT-AVR patients and 9.7±5.4 hours for AVR patients (p = 0.003). Most PFT were worse in the AVR group than in the RAT-AVR group when performed 1 week after surgery. After 1 month, forced expiratory volume in the first second, vital capacity, and total lung capacity differed significantly in favor of the RAT-AVR group (p = 0.002, p<0.001, and p = 0.001, respectively). After 3 months, the PFT parameters still had not returned to preoperative values, but the differences were no longer significant between the RAT-AVR and AVR groups. The multivariable median regression analysis demonstrated that RAT-AVR surgery was a key factor in a patient's higher postoperative PFT parameter values. CONCLUSIONS RAT-AVR surgery resulted in shorter postoperative mechanical ventilation time and improved the recovery of pulmonary function in elderly patients, but it did not reduce the incidence of pulmonary complications when compared with surgery performed through a median sternotomy.
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Affiliation(s)
- Jarosław Stoliński
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
| | - Dariusz Plicner
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
| | - Bogusław Gawęda
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
| | - Robert Musiał
- Department of Anaesthesiology and Intensive Therapy, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
| | - Kamil Fijorek
- Department of Statistics, Cracow University of Economics, Cracow, Poland
| | - Marcin Wąsowicz
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Department of Anaesthesia, University of Toronto, Toronto, Canada
| | - Janusz Andres
- Department of Anaesthesiology and Intensive Therapy, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
| | - Bogusław Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
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12
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Raza S, Sabik JF, Rajeswaran J, Idrees JJ, Trezzi M, Riaz H, Javadikasgari H, Nowicki ER, Svensson LG, Blackstone EH. Enhancing the Value of Population-Based Risk Scores for Institutional-Level Use. Ann Thorac Surg 2016; 102:70-7. [PMID: 26952298 DOI: 10.1016/j.athoracsur.2015.12.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 12/14/2015] [Accepted: 12/22/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND We hypothesized that factors associated with an institution's residual risk unaccounted for by population-based models may be identifiable and used to enhance the value of population-based risk scores for quality improvement. METHODS From January 2000 to January 2010, 4,971 patients underwent aortic valve replacement (AVR), either isolated (n = 2,660) or with concomitant coronary artery bypass grafting (AVR+CABG; n = 2,311). Operative mortality and major morbidity and mortality predicted by The Society of Thoracic Surgeons (STS) risk models were compared with observed values. After adjusting for patients' STS score, additional and refined risk factors were sought to explain residual risk. Differences between STS model coefficients (risk-factor strength) and those specific to our institution were calculated. RESULTS Observed operative mortality was less than predicted for AVR (1.6% [42 of 2,660] vs 2.8%, p < 0.0001) and AVR+CABG (2.6% [59 of 2,311] vs 4.9%, p < 0.0001). Observed major morbidity and mortality was also lower than predicted for isolated AVR (14.6% [389 of 2,660] vs 17.5%, p < 0.0001) and AVR+CABG (20.0% [462 of 2,311] vs 25.8%, p < 0.0001). Shorter height, higher bilirubin, and lower albumin were identified as additional institution-specific risk factors, and body surface area, creatinine, glomerular filtration rate, blood urea nitrogen, and heart failure across all levels of functional class were identified as refined risk-factor variables associated with residual risk. In many instances, risk-factor strength differed substantially from that of STS models. CONCLUSIONS Scores derived from population-based models can be enhanced for institutional level use by adjusting for institution-specific additional and refined risk factors. Identifying these and measuring differences in institution-specific versus population-based risk-factor strength can identify areas to target for quality improvement initiatives.
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Affiliation(s)
- Sajjad Raza
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph F Sabik
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jay J Idrees
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Matteo Trezzi
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Haris Riaz
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hoda Javadikasgari
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward R Nowicki
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
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Borger MA, Dohmen PM, Knosalla C, Hammerschmidt R, Merk DR, Richter M, Doenst T, Conradi L, Treede H, Moustafine V, Holzhey DM, Duhay F, Strauch J. Haemodynamic benefits of rapid deployment aortic valve replacement via a minimally invasive approach: 1-year results of a prospective multicentre randomized controlled trial. Eur J Cardiothorac Surg 2016; 50:713-720. [DOI: 10.1093/ejcts/ezw042] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/26/2016] [Accepted: 02/03/2016] [Indexed: 01/22/2023] Open
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14
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Wahlers TCW, Haverich A, Borger MA, Shrestha M, Kocher AA, Walther T, Roth M, Misfeld M, Mohr FW, Kempfert J, Dohmen PM, Schmitz C, Rahmanian P, Wiedemann D, Duhay FG, Laufer G. Early outcomes after isolated aortic valve replacement with rapid deployment aortic valve. J Thorac Cardiovasc Surg 2016; 151:1639-47. [PMID: 26892076 DOI: 10.1016/j.jtcvs.2015.12.058] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 12/01/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Minimal access aortic valve replacement is associated with favorable clinical outcomes; however, several meta-analyses have reported significantly longer crossclamp times compared with a full sternotomy. We examined the procedural and early safety outcomes after isolated rapid deployment aortic valve replacement by surgical approach in patients enrolled in the Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve trial. METHODS The Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve trial was a prospective, multicenter, single-arm study, with successful implants in 287 patients with aortic valve stenosis who underwent rapid deployment aortic valve replacement using the EDWARDS INTUITY Valve System (Edwards Lifesciences, Irvine, Calif). Patients were evaluated perioperatively for procedural times and technical success rates; at discharge, for hospital length of stay; and, at 30 days, for early adverse events. RESULTS A total of 158 patients underwent isolated aortic valve replacement through a full sternotomy (n = 71), upper hemisternotomy (n = 77), or right anterior thoracotomy (n = 10). Mean age at baseline was 75.7 ± 7.2 years. Mean aortic crossclamp and cardiopulmonary bypass times (minutes) were similar for full sternotomy and upper hemisternotomy, 43.5 ± 32.5/71.6 ± 41.8 and 43.1 ± 13.1/69.6 ± 19.1, respectively, and significantly longer for right anterior thoracotomy, 88.3 ± 18.6/122.2 ± 22.1 (P < .000). Early adverse event rates were similar, and in-hospital mortality rates were low regardless of surgical approach. CONCLUSIONS These data suggest that isolated rapid deployment aortic valve replacement through an upper hemisternotomy can lead to shorter crossclamp times than has been reported historically in the literature. This may facilitate minimal access aortic valve replacement by eliminating the issue of prolonged crossclamp times. Further, low in-hospital mortality and new permanent pacemaker implant rates were observed regardless of surgical approach.
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15
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Outcomes of Patients With Severe Chronic Lung Disease Who Are Undergoing Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2015; 100:2136-45; discussion 2145-6. [DOI: 10.1016/j.athoracsur.2015.05.075] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 12/19/2022]
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16
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Tong MZ, Pattakos G, He J, Rajeswaran J, Kattan MW, Barsoum WK, Blackstone EH, Johnston DR. Sequentially Updated Discharge Model for Optimizing Hospital Resource Use and Surgical Patients’ Satisfaction. Ann Thorac Surg 2015; 100:2174-81. [DOI: 10.1016/j.athoracsur.2015.05.090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/11/2015] [Accepted: 05/15/2015] [Indexed: 11/16/2022]
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Johnston DR, Roselli EE. Minimally invasive aortic valve surgery: Cleveland Clinic experience. Ann Cardiothorac Surg 2015; 4:140-7. [PMID: 25870809 DOI: 10.3978/j.issn.2225-319x.2014.10.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/07/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Minimally invasive surgery has become a routine approach for aortic valve disease over the last 18 years at the Cleveland Clinic. It is performed in isolation or in combination with other procedures. The objective of this study is to review trends and outcomes in these patients. METHODS Cleveland Clinic Cardiovascular Information Registry (CVIR) was searched for aortic valve procedures from 1996 to 2013. All patients undergoing isolated or combined aortic valve operations were included for analysis. The incision type and procedure type were reviewed and trends were evaluated over time. Cleveland Clinic outcomes with minimally invasive approaches to the aortic valve are reviewed. RESULTS A total of 22,766 aortic valve surgical procedures were performed in this 18-year timeframe. Of these, 3,385 (14.9%) were minimally invasive procedures (MIPs) and 2,379 (10.5%) were isolated minimally invasive aortic valves. MIPs increased from 12.4% to 29.6% of the total aortic valve volume over the period of the study. Combined procedures, including concomitant surgery on the aorta, mitral valve, tricuspid valve, and arrhythmia surgery increased over time as well. Overall mortality for primary and reoperative aortic valve operations continues to decline and has consistently been less than 1% for several years. CONCLUSIONS A programmed approach to minimally invasive aortic valve surgery (MIAVS) with careful patient selection, appropriate use of preoperative imaging, and selective conversion to sternotomy when necessary, allows for aortic valve replacement (AVR) and a wide range of concomitant procedures to be performed safely in a large number of patients.
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Affiliation(s)
- Douglas R Johnston
- Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric E Roselli
- Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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