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Fatehi Hassanabad A, Fatehi Hassanabad M, Israr-Ul-Haq M, Maitland A, Kent WD. Midterm Outcomes of Right Anterior Mini Thoracotomy Aortic Valve Replacement. CJC Open 2024; 6:1484-1490. [PMID: 39735951 PMCID: PMC11681344 DOI: 10.1016/j.cjco.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 09/09/2024] [Indexed: 12/31/2024] Open
Abstract
Background Contemporary surgical approaches for aortic valve replacement (AVR) include full median sternotomy, hemi-sternotomy, and a right anterior mini thoracotomy (RAMT) approach. We report the midterm outcomes of RAMT for isolated AVR. Methods A retrospective study was conducted, reporting the midterm outcomes of patients who underwent isolated RAMT AVR. The primary outcomes were death and disabling stroke within 30-days of surgery. The secondary outcomes were survival at latest follow-up assessment, hospital readmission for aortic valve disease, prosthetic valve function, and incidence of structural valve deterioration requiring reintervention on the aortic valve. Results Seventy patients underwent isolated RAMT AVR between February 2016 and February 2018. One patient died from a cardiac cause within 30 days of surgery, whereas none experienced disabling postoperative strokes. The mean follow-up period for the cohort was 74.46 ± 7.54 months. At 95 months, a total of 49 patients were alive. During the follow-up period, 2 patients underwent median sternotomy, 1 for mitral valve replacement and tricuspid repair, and 1 for coronary artery bypass grafting. At last follow-up assessment, the average mean transvalvular gradient was 12.11 ± 9.15 mm Hg. One patient developed prosthetic valve infective endocarditis, and 1 patient was found to have prosthetic valve thrombosis. Prosthetic valve function was normal in 66 patients. At 95 months, freedom from aortic valve reintervention was 98.6%, as 1 patient required redo aortic root surgery. Conclusions RAMT AVR can be done safely in the appropriate patient population. Midterm outcomes at our centre are promising, and they suggest that this approach is a good option for managing aortic stenosis.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mortaza Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Muhammad Israr-Ul-Haq
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Maitland
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - William D.T. Kent
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
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Fatehi Hassanabad A, King MA, Karolak W, Dokollari A, Castejon A, de Waard D, Smith HN, Holloway DD, Adams C, Kent WDT. Right Anterior Minithoracotomy Approach for Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:494-508. [PMID: 39305215 PMCID: PMC11619196 DOI: 10.1177/15569845241276876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2024]
Abstract
By sparing the sternum, the right anterior minithoracotomy (RAMT) approach may facilitate a quicker functional recovery when compared with conventional aortic valve replacement (AVR). In the following review, outcomes after RAMT AVR are compared with full sternotomy AVR. The RAMT approach is described, including suggestions for patient selection. The application of the RAMT approach for other cardiac procedures is also discussed.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
| | - Melissa A. King
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
| | - Wojtek Karolak
- Department of Cardiac Surgery, Medical University of Gdansk, Poland
| | - Aleksander Dokollari
- Section of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Aizel Castejon
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
| | - Dominique de Waard
- Division of Cardiac Surgery, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Holly N. Smith
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
| | - Daniel D. Holloway
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
| | - Corey Adams
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
| | - William D. T. Kent
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
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Bacchi B, Cabrucci F, Chiarello B, Dokollari A, Bonacchi M. Impact of Pleural Integrity Preservation After Minimally Invasive Aortic Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:298-305. [PMID: 39066657 DOI: 10.1177/15569845241237241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
OBJECTIVE While the benefits of minimally invasive aortic valve surgery compared with standard sternotomy have been widely described, the impact of preservation of pleural integrity (PPI) in minimally invasive surgery is still widely discussed. This study aims to define the role of PPI on postoperative and long-term outcomes after minimally invasive aortic valve replacement (MIAVR). METHODS All 2,430 consecutive patients undergoing MIAVR (ministernotomy or right anterior minithoracotomy) between 1997 and 2022 were included in the study. Patients were divided into 2 groups: patients with and without PPI. PPI was considered the maintenance of the pleura closed without the need for a chest tube insertion at the end of the surgical procedure. A propensity-matched analysis was used to compare the PPI and not-PPI groups. RESULTS After propensity matching, 848 patients were included in each group (PPI and not-PPI). The mean age was 70.21 versus 71.42 years, and the mean Society of Thoracic Surgeons predicted risk of mortality was 0.31% versus 0.30% in not-PPI versus PPI, respectively. The mean follow-up time was 147.4 months. Postoperatively, not-PPI versus PPI patients had a longer intensive care unit stay (9.7 vs 17.3 h, P < 0.001) and hospital length of stay (5.2 vs 8.9 days, P < 0.001). The rate of respiratory complications including the incidence of pneumothorax or subcutaneous emphysema, pulmonary atelectasis, and pleural effusion events requiring thoracentesis/drainage was significantly higher in not-PPI versus PPI. The 30-day all-cause mortality was higher in not-PPI versus PPI (0.029 vs 0.010, P = 0.003). Perioperative, short-term, and long-term all-cause mortality was significantly higher in the not-PPI group. CONCLUSIONS PPI after MIAVR is associated with reduced incidence of postoperative complications, reduced lengths of stay, and improved overall survival compared with not-PPI. Therefore, a MIAVR tailored patient-procedure approach to maintaining the pleura integrity positively impacts short-term and long-term outcomes.
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Affiliation(s)
- Beatrice Bacchi
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Francesco Cabrucci
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Bruno Chiarello
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Aleksander Dokollari
- Department of Cardiac Surgery, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA
| | - Massimo Bonacchi
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Italy
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Dokollari A, Torregrossa G, Sicouri S, Cameli M, Mandoli GE, Kjelstrom S, Prifti E, Veshti A, Bonacchi M, Gelsomino S. Long-term prognosis in patients undergoing redo-isolated aortic valve replacement. Future Cardiol 2023; 19:685-694. [PMID: 38078413 DOI: 10.2217/fca-2023-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Abstract
Aim: To evaluate clinical outcomes after redo aortic valve replacement (AVR) with sutured valves, versus valve-in-valve transcatheter aortic valve replacement (ViV-TAVR), versus sutureless valves. Methods: We identified 113 consecutive patients undergoing redo AVR with either ViV-TAVR, redo-sutured and redo-sutureless valves between August 2010 to March 2020. Heart-team made the decision whether patient should undergo redo-sutureless versus ViV-TAVR, versus redo-sutured AVR. Results: Preoperatively, redo-sutured (n = 57), ViV-TAVR (n = 31) and redo-sutureless (n = 25) patients were compared. Postoperatively, after propensity-adjustment analysis, the redo surgical aortic valve replacement group had a higher incidence of new postoperative atrial fibrillation (POAF; p = 0.04) compared with redo-sutureless group. Follow-up outcomes analysis did not show differences among groups. Conclusion: Patients undergoing redo-sutureless AVR experienced a higher incidence of POAF compared with patients undergoing redo-sutured.
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Affiliation(s)
- Aleksander Dokollari
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiac Surgery Department, St. Boniface Hospital, University of Manitoba, Winnipeg M3B1W7, Canada
| | | | - Serge Sicouri
- Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University Hospital of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University Hospital of Siena, Siena, Italy
| | | | - Edvin Prifti
- Division of Cardiac Surgery University Hospital Center "Mother Teresa" Tirana Albania
| | - Altin Veshti
- Division of Cardiac Surgery University Hospital Center "Mother Teresa" Tirana Albania
| | - Massimo Bonacchi
- Department of Experimental & Clinical Medicine, University of Florence, Firenze, Italy
| | - Sandro Gelsomino
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands
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Sellin C, Belmenai A, Asch S, Voß M, Dörge H. Novel concept of less invasive concomitant surgical aortic valve replacement and coronary artery bypass grafting avoiding full median sternotomy. Heart Vessels 2023; 38:1298-1303. [PMID: 37393381 DOI: 10.1007/s00380-023-02281-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
In the last decades, minimally invasive procedures have been developed in the therapy of aortic valve disorders. Recently, a novel concept of minimally invasive coronary revascularization in multivessel disease via left anterior mini-thoracotomy demonstrated promising results. Full median sternotomy, as a very invasive procedure, is the standard approach in concomitant surgical aortic valve replacement (sAVR) and coronary bypass grafting (CABG). The aim of our study was to show that the combination of minimal invasive aortic valve replacement via upper mini-sternotomy and coronary artery bypass grafting via left anterior mini-thoracotomy is feasible to avoid full median sternotomy. From 07/2022 to 09/2022, concomitant sAVR via upper partial sternotomy and CABG via left anterior mini-thoractomy on cardiopulmonary bypass and cardioplegic arrest was successfully performed in six consecutive patients (6 males; 69.8 ± 7.4 [60-79] years). All patients had severe aortic stenosis (MPG 45.5 ± 17.3 mmHg) and a significant coronary artery disease (three-vessel: 33%, two-vessel: 33%, one-vessel: 33%) with indication to cardiac surgery. Mean EuroScore2 was 3.2. All patients underwent successful less invasive concomitant biological sAVR and CABG. 67% of patients received a 25 mm, 33% received a 23 mm biological aortic valve replacement (Edwards Lifesciences Perimount). A total of 11 distal anastomoses (1.8 ± 1.0 [1-3] per patient) were performed by using left internal artery mammary (50%), radial artery (17%) and saphenous venous graft (67%) for grafting the left anterior descending (83%), circumflex (67%) and right (33%) coronary artery. Hospital mortality was 0%, stroke rate was 0%, myocardial infarction was 0% and repeat revascularization rate was 0%, ICU stay was 1 day in 83% of all patients and 50% left hospital within 8 days after surgery. Less invasive concomitant surgical aortic valve replacement and coronary artery bypass grafting using upper mini-sternotomy and left anterior mini-thoracotomy is feasible without compromises in surgical principles and complete coronary revascularization while maintaining thoracic stability by avoiding full median sternotomy.
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Affiliation(s)
- Christian Sellin
- Department of Cardiothoracic Surgery, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Germany.
| | - Ahmed Belmenai
- Department of Cardiothoracic Surgery, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Germany
| | - Silke Asch
- Department of Cardiothoracic Surgery, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Germany
| | - Meinolf Voß
- Department of Cardiothoracic Surgery, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Germany
| | - Hilmar Dörge
- Department of Cardiothoracic Surgery, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Germany
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Bonacchi M, Cabrucci F, Bacchi B, Dokollari A. Reply from authors: Dazzling like an art(ist), worthwhile like a craftsman. JTCVS OPEN 2023; 14:90-91. [PMID: 37425432 PMCID: PMC10329033 DOI: 10.1016/j.xjon.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
- Massimo Bonacchi
- Cardiac Surgery F.U., Experimental and Clinical Medicine Department, University of Florence, Firenze, Italy
| | - Francesco Cabrucci
- Cardiac Surgery F.U., Experimental and Clinical Medicine Department, University of Florence, Firenze, Italy
| | - Beatrice Bacchi
- Cardiac Surgery F.U., Experimental and Clinical Medicine Department, University of Florence, Firenze, Italy
| | - Aleksander Dokollari
- Department of Cardiac Surgery, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pa
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Wu YS, Ghatanatti R, Zacharias J. Is it the art or the artist? JTCVS OPEN 2023; 14:89. [PMID: 37425450 PMCID: PMC10328835 DOI: 10.1016/j.xjon.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
- Yung-Szu Wu
- Division of Cardiovascular Surgery, Cardiovascular Centre, Taichung Veterans General Hospital, Taichung City, Taiwan
- Cardiothoracic Surgery Department, Blackpool Victoria Hospital, Lancashire, United Kingdom
| | - Ravi Ghatanatti
- Cardiothoracic Surgery Department, Blackpool Victoria Hospital, Lancashire, United Kingdom
| | - Joseph Zacharias
- Cardiothoracic Surgery Department, Blackpool Victoria Hospital, Lancashire, United Kingdom
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8
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Bonacchi M, Bacchi B, Cabrucci F, Tevaearai Stahel H, Jeenchen Chen R, Dokollari A. Editorial: Insights in heart surgery: 2022. Front Cardiovasc Med 2023; 10:1184097. [PMID: 37139120 PMCID: PMC10150089 DOI: 10.3389/fcvm.2023.1184097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Affiliation(s)
- Massimo Bonacchi
- Cardiac Surgery F.U., Experimental and Clinical Medicine Department, University of Florence, Firenze, Italy
| | - Beatrice Bacchi
- Cardiac Surgery F.U., Experimental and Clinical Medicine Department, University of Florence, Firenze, Italy
| | - Francesco Cabrucci
- Cardiac Surgery F.U., Experimental and Clinical Medicine Department, University of Florence, Firenze, Italy
| | | | - Robert Jeenchen Chen
- Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Aleksander Dokollari
- Department of Cardiac Surgery, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, United States
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9
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Orozco-Sevilla V, Salerno TA. Commentary: Is minimally invasive cardiac surgery a Chimera? J Thorac Cardiovasc Surg 2023; 165:1034-1035. [PMID: 34016452 DOI: 10.1016/j.jtcvs.2021.04.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Vicente Orozco-Sevilla
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex
| | - Tomas A Salerno
- Division of Cardiothoracic Surgery, Miller School of Medicine, University of Miami, and Jackson Memorial Hospital, Miami, Fla.
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Laurin C, Dagenais F. Commentary: Minimally invasive aortic valve replacement in the transcatheter aortic valve replacement era: Where do we stand? J Thorac Cardiovasc Surg 2023; 165:1033-1034. [PMID: 34059336 DOI: 10.1016/j.jtcvs.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Charles Laurin
- Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - François Dagenais
- Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada.
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11
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Ogami T, Yokoyama Y, Takagi H, Serna-Gallegos D, Ferdinand FD, Sultan I, Kuno T. Minimally invasive versus conventional aortic valve replacement: The network meta-analysis. J Card Surg 2022; 37:4868-4874. [PMID: 36378939 DOI: 10.1111/jocs.17126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Outcome comparisons after surgical aortic valve replacement (SAVR) with minimally invasive approaches including mini-sternotomy (MS) and right mini-thoracotomy (RMT) and full sternotomy (FS) have been conflicting. Furthermore, the synthesis of mid-term mortality has not been performed. METHODS MEDLINE and EMBASE were searched through April 2022 to identify propensity score matched (PSM) studies or randomized controlled trial (RCT) which compared outcomes following SAVR among three incisional approaches: FS, MS, or RMT. The network analysis was performed to compare these approaches with random effects model. Mid-term mortality was defined as 1-year mortality. RESULTS A total of 42 studies met the inclusion criteria enrolling 14,925 patients. RCT and PSM were performed in 13 and 29 studies, respectively. The operative mortality was significantly lower with MS compared to FS (risk ratio [RR]: 0.60, 95% confidence interval [CI]: 0.41-0.90, p = .01, I2 = 25.8%) or RMT (RR: 0.51, 95% CI: 0.27-0.97, p = .03, I2 = 25.8%). RMT had significantly higher risk of reoperation for bleeding compared to MS (RR: 1.65, 95% CI: 1.18-2.30, p = .003, I2 = 0%). Hospital length of stay was significantly shorter with MS compared to FS (mean difference: -0.89 days, 95% CI: -1.58 to -0.2, p = .01, I2 = 95.5%) while it was equivocal between FS and RMT. The mid-term mortality was similar among the three approaches. CONCLUSIONS While mid-term mortality was comparable among approaches, MS may be a safe and potentially more effective approach than FS and RMT for SAVR in the short term.
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Affiliation(s)
- Takuya Ogami
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Yujiro Yokoyama
- Department of Surgery, St. Luke's University Health Network, Fountain Hill, Pennsylvania, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Derek Serna-Gallegos
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Cardiothroacic Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pennsylvania, Pittsburgh, USA
| | - Francis D Ferdinand
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Cardiothroacic Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pennsylvania, Pittsburgh, USA
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Cardiothroacic Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pennsylvania, Pittsburgh, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, New York, USA
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Abd Al Jawad M, Mourad F. Measurement of health-related quality of life post aortic valve replacement via minimally invasive incisions. J Cardiothorac Surg 2022; 17:208. [PMID: 36028838 PMCID: PMC9414161 DOI: 10.1186/s13019-022-01964-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Minimally invasive aortic surgery is growing in popularity among surgeons. Although many clinical reports have proven both the safety and efficacy from a surgical point of view, there are few data regarding its impact on patients’ quality of life and whether there is a difference between ministernotomy and minithoracotomy from the patient perspective. Methods This prospective, questionnaire-based, nonrandomized study included 189 patients who underwent aortic valve replacement via a minimally invasive incision between May 2014 and December 2020 and completed at least 1 year of follow-up. The study uses the RAND SF 36-Item Health Survey 1.0 to assess and compare health-related quality of life between ministernotomy and minithoracotomy. Results There was a statistically significant improvement in the minithoracotomy group with regard to physical functioning, role limitation due to a physical problem, and social functioning (79.69 ± 20.72, 75.28 ± 26.52, 87.91 ± 16.98) compared to the ministernotomy group (70.31 ± 22.88, 58.59 ± 31.17, 66.15 ± 27.32) with p values (0.0036, 0.0001, < 0.0001), respectively. Conclusions Both minimally invasive aortic valve incisions positively impacted patient quality of life. The minithoracotomy incision showed significant improvements in physical capacity and successful patient re-engagement in daily physical and social activities. This, in turn, positively improved their general health status compared to the 1-year preoperative status. Trial registration: This study was approved by the Research Ethics Committee (REC) at the Faculty of Medicine, Ain Shams University, under the number code (FWA 000017585, FAMSU R 91 /2021).
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Affiliation(s)
- Mohammed Abd Al Jawad
- Department of Cardiothoracic Surgery, Ain Shams University, Abbaseya Square, Cairo, Egypt.
| | - Faisal Mourad
- Department of Cardiothoracic Surgery, Ain Shams University, Abbaseya Square, Cairo, Egypt
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13
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Dokollari A, Prifti E, Torregrossa G, Bonacchi M. Commentary: New technology impact on chest tube clotting after cardiac surgery. A possible paradigm shift? JTCVS OPEN 2022; 10:254-255. [PMID: 36004255 PMCID: PMC9390773 DOI: 10.1016/j.xjon.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 02/23/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Aleksander Dokollari
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht, The Netherlands
| | - Edvin Prifti
- Department of Cardiac Surgery, Mother Teresa Hospital, University of Tirana, Tirana, Albania
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pa
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pa
| | - Massimo Bonacchi
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
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14
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90-Day Patient-Centered Outcomes after Totally Endoscopic Cardiac Surgery: A Prospective Cohort Study. J Clin Med 2022; 11:jcm11092674. [PMID: 35566800 PMCID: PMC9103144 DOI: 10.3390/jcm11092674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/29/2022] [Accepted: 05/08/2022] [Indexed: 01/27/2023] Open
Abstract
Over the past years, minimally invasive procedures have been developed to reduce surgical trauma after cardiac surgery. The value of patient-centered outcomes, including the quality of recovery after hospital discharge, is increasingly recognized. Identifying meaningful changes in postoperative function that might have a negative impact on patients without noticeable complications can provide a more comprehensive understanding of the impact on the patient’s life. In total, 209 patients were included in this trial. Of these, 193 patients underwent totally endoscopic cardiac surgery, 8 underwent cardiac surgery through a sternotomy, and 8 underwent transcatheter aortic valve implantation. Patients who previously underwent cardiac surgery were excluded. Quality of life was determined through the Short Form 36 and European Quality of Life-5 Dimensions questionnaires before the surgery and 14, 30, and 90 days afterward. In patients who underwent totally endoscopic cardiac surgery, the quality of life improved over the three time periods. The different domains of the questionnaire evolved in a positive manner. However, 14 days postoperatively, a decline in quality of life was noted, followed by a return to baseline at 30 days and an increase at 90 days. In conclusion, totally endoscopic cardiac surgery improves the quality of life 90 days after surgery.
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15
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Dokollari A, Ramlawi B, Torregrossa G, Sá MP, Sicouri S, Prifti E, Gelsomino S, Bonacchi M. Benefits and Pitfalls of the Perceval Sutureless Bioprosthesis. Front Cardiovasc Med 2022; 8:789392. [PMID: 35071358 PMCID: PMC8766961 DOI: 10.3389/fcvm.2021.789392] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/29/2021] [Indexed: 12/04/2022] Open
Abstract
Objective: To highlight the main target points covered by clinical studies on the Perceval sutureless valve for surgical aortic valve replacement (SAVR) and raise a point of discussion for further expansion of its use when compared with stented bioprostheses (SB) and transcatheter aortic valve replacement (TAVR). Methods: We reviewed clinical trials and retrospective studies published up to date and compared the outcomes in terms of mortality, myocardial infarction (MI) stroke, paravalvular leak (PVL), permanent pacemaker implantation (PPI), bleeding and long-term outcomes. Results: Clinical studies showed that 30-day mortality ranged from 0-4% for Perceval and 2.9-7% for TAVR. The incidence of PVL (Perceval 1.9-19.4 vs. TAVR 9-53.5%), PPI (Perceval 2-11.2 vs. TAVR 4.9-25.5%), stroke (Perceval 0 vs. TAVR 0-2.8%), MI (Perceval 0 vs. TAVR 0-3.5%), were all higher in the TAVR group. Compared to other SB, mortality ranged from 0-6.4% for Perceval and 0-5.9% for SB. The incidence of PVR (Perceval 1-19.4 vs. SB 0-1%), PPI (Perceval 2-10.7 vs. SB 1.8-8.5%), stroke (Perceval 0-3.7 vs. SB 1.8-7.3%) and MI (Perceval 0-7.8 vs. SB 0-4.3%) were comparable among the groups. In patients with a bicuspid aortic valve, mortality rate was (0-4%) and PVL incidence was (0-2.3%). However, there was a high incidence of PPI (0-20%), and stroke (0-8%). Long-term survival ranged between 96.7-98.6%. Conclusions: The Perceval bioprosthesis has proved to be a reliable prosthesis for surgical aortic valve replacement due to its implantation speed, the reduced cardiopulmonary bypass time, the reduced aortic cross-clamp time and the shorter intensive care unit and hospital length of stay.
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Affiliation(s)
| | - Basel Ramlawi
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Michel Pompeu Sá
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Serge Sicouri
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Edvin Prifti
- Mother Teresa Hospital, University of Tirana, Tirana, Albania
| | - Sandro Gelsomino
- Department of Cardiac Surgery, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht—CARIM, Maastricht, Netherlands
| | - Massimo Bonacchi
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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