Single Centre Experience with Minimally Invasive Aortic Valve Replacement versus Conventional Full Sternotomy Approach - A Propensity Match Analysis

Background/Introduction

Minimally invasive approach to aortic valve replacement (AVR) is increasingly accepted as a valid alternative to conventional full sternotomy (FS-AVR), as reduces operative trauma with the final aim to improve the postoperative outcomes.

Aims/Objectives

The aim of our study is to compare short term clinical outcomes after minimally invasive AVR (mini-AVR) with outcomes following FS-AVR in the same institution.

Method

Between December 2010 and March 2012 627 patients underwent isolated AVR were retrospectively included in two groups: 599 patients underwent FS-AVR sternotomy (Group A), while 28 underwent minimally invasive procedure (Group B). Mini-AVR was performed through a 6 cm upper midline incision with reverse 'J' manubriotomy carried into the right third intercostal space. Venous drainage for cardiopulmonary bypass was achieved alternatively percutaneously or with a flat two stage venous cannula with vacuum assist. Primary endpoint was peri-procedural mortality; secondary endpoints were overall postoperative complications, major adverse cardiac-related complication, use of blood products and need for transfusions, bypass time and cross-clamp time, ventilation time and length of stay in hospital. Propensity score match analysis was performed to avoid selection biases and equalize confounding preoperative variables.

Results

After propensity score match, no statistical significant difference was found in peri-procedural mortality rate (p > 0.05), mean bypass and cross clamp times. Minimally invasive AVR was associated with a significant reduced need for transfusion (p = 0.003), as well as postoperative cardiac and non-cardiac complications. A trend towards lower mean ventilation times, ICU stay and hospital stay in the mini-AVR group was also detected, but failed to reach statistical significance.

Discussion/Conclusion

Initial results with minimally invasive AVR are associated with significantly reduced blood loss, reduced blood transfusion and a trend towards less ventilation time, ICU stay and hospital stay. Postoperative cosmetic results were much better in the minimally invasive group.