Aortic valve replacement in patients with a left ventricular ejection fraction <= 35% performed via a minimally invasive right thoracotomy

作者：Santana Orlando^*; Xydas Steve; Williams Roy F; La Pietra Angelo; Mawad Maurice; Behrens Vicente; Escolar Esteban; Mihos Christos G

来源：Journal of Thoracic Disease, 2017, 9(S7): S607-S613.

DOI：10.21037/jtd.2017.06.32

• Minimally invasive
• aortic stenosis
• aortic regurgitation
• valve surgery

Background: We evaluated the outcomes of patients with aortic valve pathology in the setting of a left ventricular ejection fraction <= 35% who underwent minimally invasive aortic valve replacement (AVR), with or without concomitant mitral valve (MV) surgery.
Methods: All minimally invasive AVR in patients with a left ventricular ejection fraction <= 35%, performed via a right thoracotomy for aortic stenosis or regurgitation between January 2009 and March 2013, were retrospectively evaluated. The operative characteristics, perioperative outcomes, and 30-day mortality were analyzed.
Results: There were 75 patients identified: 51 who underwent isolated AVR, and 24 who had combined AVR plus MV surgery for moderate to severe mitral regurgitation. In patients undergoing MV surgery, there were 22 (91.7%) MV repairs [ring annuloplasty =7 (37.5%), transaortic edge-to-edge repair =15 (62.5%)], and 2 (8.3%) replacements. No patient required conversion to sternotomy for inadequate surgical field exposure. The median total mechanical ventilation time and intensive care unit length of stay were 14 (IQR, 8-20) and 42 hours (IQR, 26-93 hours) in the isolated AVR group, and 16.5 hours (IQR, 12-61.5 hours) and 95.5 hours (IQR, 43.5-159 hours) in the AVR plus MV surgery group, respectively. The most common post-operative complication was new-onset atrial fibrillation, which occurred in 15 (29.4%) isolated AVR and 4 (16.7%) AVR plus MV surgery patients. The median hospital length of stay and 30-day mortality was 7 days (IQR, 5-12 days) and 1 (2%) in the isolated AVR group, and 10.5 days (IQR, 5-21 days) and 1 (4.3%) for AVR plus MV surgery.
Conclusions: In patients with aortic valve pathology in the setting of a left ventricular ejection fraction <= 35%, minimally invasive AVR can be performed, with or without concomitant MV surgery, with a low morbidity and mortality.

• 出版日期2017-6