A comparison of minimally invasive and standard aortic valve replacement

作者：Stolinski Jarosaw^*; Plicner Dariusz; Grudzien Grzegorz; Wasowicz Marcin; Musial Robert; Andres Janusz; Kapelak Bogusaw

来源：The Journal of Thoracic and Cardiovascular Surgery, 2016, 152(4): 1030-1039.

DOI：10.1016/j.jtcvs.2016.06.012

• aortic valve replacement
• minimally invasive aortic valve surgery
• right anterior minithoracotomy

Objective: The study objective was to compare aortic valve replacement through a right anterior minithoracotomy with aortic valve replacement through a median sternotomy.
Methods: With propensity score matching, we selected 211 patients after aortic valve replacement through a right anterior minithoracotomy and 211 patients after aortic valve replacement who underwent operation between January 2010 and December 2013. Perioperative outcomes were analyzed, and multivariable logistic regression analysis of risk factors of postoperative morbidity was performed.
Results: For propensity score-matched patients, hospital mortality was 1.0% in the aortic valve replacement through a right anterior minithoracotomy group and 1.4% in the aortic valve replacement group ( P = 1.000). Stroke occurred in 0.5% versus 1.4% ( P = .615), myocardial infarction occurred in 1.4% versus 1.9% ( P = 1.000), and new onset of atrial fibrillation occurred in 12.8% versus 24.2% ( P = .003) of patients in the aortic valve replacement through a right anterior minithoracotomy and aortic valve replacement groups, respectively. Postoperative drainage was 353.5 +/- 248.6 mL versus 544.3 +/- 324.5 mL ( P<. 001) and blood transfusion was required for 48.8% versus 67.3%( P<. 001) of patients in the aortic valve replacement through a right anterior minithoracotomy and aortic valve replacement groups, respectively. Mediastinitis occurred in 2.8% of patients after aortic valve replacement and in 0.0% of patients after aortic valve replacement through a right anterior minithoracotomy surgery ( P = .040). Intensive care unit stay ( 1.3 +/- 1.2 days vs 2.6 +/- 2.6 days) and hospital stay ( 5.7 +/- 1.6 days vs 8.7 +/- 4.4 days) were statistically significantly shorter in the aortic valve replacement through a right anterior minithoracotomy group. Aortic valve replacement through a right anterior minithoracotomy surgery resulted in reduced postoperative morbidity ( odds ratio, 0.4; P<. 001) and postoperative bleeding and blood transfusion requirements ( odds ratio, 0.4; P<. 001).
Conclusions: Aortic valve replacement through a right anterior minithoracotomy surgery resulted in a reduced infection rate, diminished postoperative bleeding and blood transfusion requirements, reduced occurrence of new onset of atrial fibrillation, and shorter intensive care unit and hospital stays.

• 出版日期2016-10