1
|
Kirmani BH, Akowuah E. Minimal Access Aortic Valve Surgery. J Cardiovasc Dev Dis 2023; 10:281. [PMID: 37504537 PMCID: PMC10380690 DOI: 10.3390/jcdd10070281] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Minimally invasive approaches to the aortic valve have been described since 1993, with great hopes that they would become universal and facilitate day-case cardiac surgery. The literature has shown that these procedures can be undertaken with equivalent mortality rates, similar operative times, comparable costs, and some benefits regarding hospital length of stay. The competing efforts of transcatheter aortic valve implantation for these same outcomes have provided an excellent range of treatment options for patients from cardiology teams. We describe the current state of the art, including technical considerations, caveats, and complications of minimal access aortic surgery and predict future directions in this space.
Collapse
Affiliation(s)
- Bilal H Kirmani
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Enoch Akowuah
- Cardiac Surgery, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Academic Cardiovascular Unit, South Tees NHS Foundation Trust, Middlesbrough TS4 3BW, UK
| |
Collapse
|
2
|
Vohra HA, Salmasi MY, Mohamed F, Shehata M, Bahrami B, Caputo M, Deshpande R, Bapat V, Bahrami T, Birdi I, Zacharias J. Consensus statement on aortic valve replacement via an anterior right minithoracotomy in the UK healthcare setting. Open Heart 2023; 10:e002194. [PMID: 37001910 PMCID: PMC10069572 DOI: 10.1136/openhrt-2022-002194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
The wide uptake of anterior right thoracotomy (ART) as an approach for aortic valve replacement (AVR) has been limited despite initial reports of its use in 1993. Compared with median sternotomy, and even ministernotomy, ART is considered to be less traumatic to the chest wall and to help facilitate quicker patient recovery. In this statement, a consensus agreement is outlined that describes the potential benefits of the ART AVR. The technical considerations that require specific attention are described and the initiation of an ART programme at a UK centre is recommended through simulation and/or use of specialist instruments in conventional cases. The use of soft tissue retractors, peripheral cannulation, modified aortic clamping and the use of intraoperative adjuncts, such as sutureless valves and/or automated knot fasteners, are important to consider in order to circumvent the challenges of minimal the altered exposure via an ART.A coordinated team-based approach that encourages ownership of the programme by team members is critical. A designated proctor/mentor is also recommended. The organisation of structured training and simulation, as well as planning the initial cases are important steps to consider.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Vinayak Bapat
- Cardiovascular Directorate, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | - Inderpaul Birdi
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK
| | - Joseph Zacharias
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Ammannaya GKK, Solinas M, Passino C. Analysis of the logistical, economic and minimally invasive cardiac surgical training difficulties in India. Arch Med Sci Atheroscler Dis 2020; 5:e178-e185. [PMID: 32832718 PMCID: PMC7433791 DOI: 10.5114/amsad.2020.97380] [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: 04/16/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022] Open
Abstract
Significant advances have been made in minimally invasive cardiac surgery (MICS) over the past 3 decades. However, the acceptance and practice of MICS continue to remain low in the developing world owing to several challenges. This study aimed to analyse the logistical, economic and training difficulties in MICS with a special focus on the Indian scenario. A systematic review of the current literature on MICS with an emphasis on these challenges was performed. MICS has been shown to have clear cost-benefit advantage that stems from shorter ICU and hospital stay, lesser transfusion requirements and avoidance of sternal wound complications. However, only limited reports are currently available detailing the economic and training challenges for the application of MICS in the developing world, particularly India. Though several challenges exist in widening MICS practice in India, these can be overcome through a target-oriented approach.
Collapse
Affiliation(s)
| | - Marco Solinas
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Claudio Passino
- Department of Cardiology, Scuola Superiore Sant’Anna, Pisa, Italy
| |
Collapse
|
5
|
Fatehi Hassanabad A, El Idrissi KR, Kent WDT. Right anterior minithoracotomy approach for resection of papillary fibroelastoma. J Card Surg 2020; 35:1729-1731. [PMID: 32485064 DOI: 10.1111/jocs.14674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Right anterior minithoracotomy (RAMT) is an alternative to full or partial sternotomy for accessing the aortic valve. The adoption of this approach for aortic valve replacement has been limited by its perceived technical complexity. Resection of a mobile aortic valve tumor is a simple procedure that is conventionally done through a sternotomy. AIM The following case describes the resection of an aortic valve papillary fibroelastoma through an RAMT. MATERIALS & METHODS This is a report on a single patient's case. RESULTS The fibroelastoma was safely excised through a RAMT approach. DISCUSSION An aortic valve fibroelastoma offers an ideal starting point for surgeons to begin using a RAMT approach. CONCLUSION The excision of aortic valve masses is a procedure that is well suited to minimally invasive strategies, and we suggest sternum-sparing RAMT is the optimal approach.
Collapse
Affiliation(s)
- Ali Fatehi Hassanabad
- Division of Cardiac Surgery, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, Canada
| | - Kenza R El Idrissi
- Undergraduate Medical Education, Faculty of Medicine, McGill University, Montreal, Canada
| | - William D T Kent
- Division of Cardiac Surgery, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, Canada
| |
Collapse
|
6
|
Nair SK, Sudarshan CD, Thorpe BS, Singh J, Pillay T, Catarino P, Valchanov K, Codispoti M, Dunning J, Abu-Omar Y, Moorjani N, Matthews C, Freeman CJ, Fox-Rushby JA, Sharples LD. Mini-Stern Trial: A randomized trial comparing mini-sternotomy to full median sternotomy for aortic valve replacement. J Thorac Cardiovasc Surg 2018; 156:2124-2132.e31. [DOI: 10.1016/j.jtcvs.2018.05.057] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 04/23/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022]
|
7
|
International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally Invasive Approaches. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 11:165-73. [PMID: 27540996 PMCID: PMC4996354 DOI: 10.1097/imi.0000000000000287] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective To define the benefit of sutureless and rapid deployment valves in current minimally invasive approaches in isolated aortic valve replacement. Methods A panel of 28 international experts with expertise in both minimally invasive aortic valve replacement and rapid deployment valves was constituted. After thorough literature review, the experts rated evidence-based recommendations in a modified Delphi approach. Results No guideline could be retrieved. Thirty-three clinical trials and 9 systematic reviews could be identified for detailed text analysis to obtain a total of 24 recommendations. After rating by the experts 12, final recommendations were identified: preoperative computed tomographic scan as well as intraoperative transesophageal echocardiography are highly recommended. Suitable annular sizes are 19 to 27 mm. There is a contraindication for bicuspid valves only for type 0 and for annular abscess or destruction due to infective endocarditis. The use of sutureless and rapid deployment valves reduces extracorporeal circulation and aortic cross-clamp time and leads to less early complications as prolonged ventilation, blood transfusion, atrial fibrillation, pleural effusions, paravalvular leakages and aortic regurgitation, and renal replacement therapy, respectively. These clinical outcomes result in reduced intensive care unit and hospital stay and reduced costs. The use of sutureless and rapid deployment valves will lead to a higher adoption rate of minimally invasive approaches in aortic valve replacement. Respect should be taken to a necessary short learning curve for both sutureless and minimally invasive programs. Conclusions Sutureless and rapid deployment aortic valve replacement together with minimally invasive approaches offers an attractive option in aortic valve placement for patients requiring biological valve replacement.
Collapse
|
8
|
Abstract
Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replacement is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper sternotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease.
Collapse
|
9
|
Fattouch K, Moscarelli M, Del Giglio M, Albertini A, Comoglio C, Coppola R, Nasso G, Speziale G. Non-sutureless minimally invasive aortic valve replacement: mini-sternotomy versus mini-thoracotomy: a series of 1130 patients. Interact Cardiovasc Thorac Surg 2016; 23:253-8. [PMID: 27160409 DOI: 10.1093/icvts/ivw104] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 03/04/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Aortic valve replacement through conventional sternotomy still represents the gold-standard surgical approach for aortic valve disease. However, given the increasing number of patients with comorbidities, strategies that can improve operative results are always sought. Minimally invasive aortic valve surgery, although related to a steep learning curve, might be associated with improved postoperative outcomes. The main aim of this study was to assess whether significant differences exist in terms of operative and early results between a mini-sternotomy and a right mini-thoracotomy approach for isolated aortic valve replacement without sutureless technologies. METHODS This is an observational retrospective multicentre study from nine Italian cardiac centres that analyses prospectively collected data of patients who underwent isolated minimally invasive aortic valve replacement between January 2010 and December 2014. Two approaches are considered (mini-sternotomy and mini-thoracotomy) and compared in terms of operative and early outcomes. RESULTS After interrogation of the centralized database, a total of 1130 patients were retrieved (854 mini-sternotomy and 276 mini-thoracotomy). Patients in the mini-sternotomy group had a higher risk profile. There was no difference in terms of early mortality; cardiopulmonary bypass and cross-clamp time did not differ significantly between the groups; and a significantly higher number of reoperations for bleeding was observed in the right mini-thoracotomy group. CONCLUSIONS Both mini-sternotomy and mini-thoracotomy could be performed safely, with low mortality and postoperative morbidity. The mini-thoracotomy approach was associated with a significantly higher rate of reoperation for bleeding. Uptake among cardiac centres was low. Sutureless technologies could potentially increase surgical volume by simplifying the mini-thoracotomy procedure.
Collapse
Affiliation(s)
- Khalil Fattouch
- Department of Surgery and Cancer, University of Palermo, Italy Department of Cardiothoracic and vascular Surgery, GVM Care and Research, Villa Maria Eleonora, Palermo, Italy
| | | | - Mauro Del Giglio
- Department of Cardiac Surgery, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Alberto Albertini
- Department of Cardiac Surgery, GVM Care and Research, Salus Hospital, Ravenna, Italy
| | - Chiara Comoglio
- Department of Cardiac Surgery, GVM Care and Research, Maria Pia Hospital, Torino, Italy
| | - Roberto Coppola
- Department of Cardiac Surgery, GVM Care and Research, Istituto Clinico Ligure Alta Specialita', Rapallo, Italy
| | - Giuseppe Nasso
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| |
Collapse
|
10
|
Ramakrishna H, Patel PA, Gutsche JT, Vallabhajosyula P, Szeto WY, MacKay E, Feinman JW, Shah R, Zhou E, Weiss SJ, Augoustides JG. Surgical Aortic Valve Replacement-Clinical Update on Recent Advances in the Contemporary Era. J Cardiothorac Vasc Anesth 2016; 30:1733-1741. [PMID: 27542900 DOI: 10.1053/j.jvca.2016.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Phoenix, AZ
| | | | | | - Prashanth Vallabhajosyula
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Ronak Shah
- Department of Anesthesiology and Critical Care
| | | | | | | |
Collapse
|
11
|
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.
Collapse
|
12
|
Abstract
With the advent of transcatheter aortic valve replacement and the emergence of rapid deployment aortic valves, there is a resurgent interest in minimizing the trauma of surgical aortic valve replacement (AVR). The present review summarizes the history of minimal access AVR and attempts to collate the existing evidence regarding minimal access AVR.
Collapse
Affiliation(s)
- Rawn Salenger
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Julia A Collins
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
13
|
Gilmanov D, Solinas M, Farneti PA, Cerillo AG, Kallushi E, Santarelli F, Glauber M. Minimally invasive aortic valve replacement: 12-year single center experience. Ann Cardiothorac Surg 2015; 4:160-9. [PMID: 25870812 DOI: 10.3978/j.issn.2225-319x.2014.12.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 12/08/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND This study reports the single center experience on minimally invasive aortic valve replacement (MIAVR), performed through a right anterior minithoracotomy or ministernotomy (MS). METHODS Eight hundred and fifty-three patients, who underwent MIAVR from 2002 to 2014, were retrospectively analyzed. Survival was evaluated using the Kaplan-Meier method. The Cox multivariable proportional hazards regression model was developed to identify independent predictors of follow-up mortality. RESULTS Median age was 73.8, and 405 (47.5%) of patients were female. The overall 30-day mortality was 1.9%. Four hundred and forty-three (51.9%) and 368 (43.1%) patients received biological and sutureless prostheses, respectively. Median cardiopulmonary bypass time and aortic cross-clamping time were 108 and 75 minutes, respectively. Nineteen (2.2%) cases required conversion to full median sternotomy. Thirty-seven (4.3%) patients required re-exploration for bleeding. Perioperative stroke occurred in 15 (1.8%) patients, while transient ischemic attack occurred postoperative in 11 (1.3%). New onset atrial fibrillation was reported for 243 (28.5%) patients. After a median follow-up of 29.1 months (2,676.0 patient-years), survival rates at 1 and 5 years were 96%±1% and 80%±3%, respectively. Cox multivariable analysis showed that advanced age, history of cardiac arrhythmia, preoperative chronic renal failure, MS approach, prolonged mechanical ventilation and hospital stay as well as wound revision were associated with higher mortality. CONCLUSIONS MIAVR via both approaches is safe and feasible with excellent outcomes, and is associated with low conversion rate and low perioperative morbidity. Long term survival is at least comparable to that reported for conventional sternotomy AVR.
Collapse
Affiliation(s)
- Daniyar Gilmanov
- Department of Adult Cardiac Surgery, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart hospital, Massa, MS 54100, Italy
| | - Marco Solinas
- Department of Adult Cardiac Surgery, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart hospital, Massa, MS 54100, Italy
| | - Pier Andrea Farneti
- Department of Adult Cardiac Surgery, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart hospital, Massa, MS 54100, Italy
| | - Alfredo Giuseppe Cerillo
- Department of Adult Cardiac Surgery, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart hospital, Massa, MS 54100, Italy
| | - Enkel Kallushi
- Department of Adult Cardiac Surgery, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart hospital, Massa, MS 54100, Italy
| | - Filippo Santarelli
- Department of Adult Cardiac Surgery, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart hospital, Massa, MS 54100, Italy
| | - Mattia Glauber
- Department of Adult Cardiac Surgery, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart hospital, Massa, MS 54100, Italy
| |
Collapse
|
14
|
Grossi EA, Moore M, Mallow PJ, Rizzo JA. The Cost of an Operating Room Minute for Heart Valve Procedures. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2015; 2:170-180. [PMID: 34430664 PMCID: PMC8341883 DOI: 10.36469/9898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background: Heart valve disease is very common, with approximately 5 million people diagnosed with this disease annually in the United States. There has been substantial innovation in the technologies and techniques of surgical repair and replacement over the past decade. However, there is little information that allows the potential time savings associated with these technologies and techniques to be quantified from the hospital perspective. Objectives: The study objective was to estimate the variable cost per operating room (OR) minute in valvular procedures - aortic valve replacement (AVR), mitral valve replacement (MVR) and mitral valve repair (MVRepair) - and determine if there is a difference in OR cost per minute between traditional sternal versus less invasive right thoracotomy surgical techniques. Methods: The Premier database was queried from 2007 to 2011 for patients undergoing AVR, MVR, or MVRepair. Patients were identified using the International Classification of Diseases, 9th Revision (ICD-9) procedure codes. Propensity score matching created cohorts adjusted for patient differences and surgical approach -any sternal incision (Sternal) or right thoracotomy (RT). Regression analysis was performed to estimate the OR cost per minute based on heart valve procedure. Results: There were 2,656 heart valve procedures - 1,604 AVR, 434 MVR and 618 MVRepair - that met the inclusion criteria. The mean OR cost per minute for AVR procedures was $26.49 and $25.16 (p <0.01) for Sternal and RT, respectively. MVR procedures by surgical approach had a mean OR cost per minute of $25.66 and $25.00 and (p NS) for Sternal and RT, respectively. MVRepair procedures by surgical approach had a mean OR cost per minute of $25.17 and $24.40 and (p NS) for Sternal and RT, respectively. The overall estimate of the OR cost per minute for valvular procedures was $25.99. Conclusions: Quantifying the variable cost of an OR minute from a multi-institution database provides researchers with an important benchmark to use in economic evaluations of valvular procedures.
Collapse
Affiliation(s)
| | - Matthew Moore
- Global Health Economic Strategy, Edwards Lifesciences Inc., Irvine, CA USA
| | - Peter J Mallow
- CTI Clinical Trial and Consulting Services, Cincinnati, OH USA
| | | |
Collapse
|