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  • Meeting abstract
  • Open Access

Single Surgeon Experience With Minimally Invasive AVR: Expectations of a Change in Practice

  • 1,
  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Journal of Cardiothoracic Surgery201510 (Suppl 1) :A120

https://doi.org/10.1186/1749-8090-10-S1-A120

  • Published:

Keywords

  • Propensity Score
  • Aortic Valve Replacement
  • Propensity Score Match
  • Relative Risk Reduction
  • Median Sternotomy

Background/Introduction

Reports of minimally invasive aortic valve replacement (miniAVR) are hampered by non-standardized techniques and multi-surgeon/institution practice.

Aims/Objectives

This study reports single surgeon/institution experience with standardized technique for AVR/miniAVR in all patients.

Method

Retrospective chart review of entire experience of a single surgeon with isolated AVR or AVR/ascending aortic replacement. Conventional median sternotomy (cAVR, n = 144) was performed from 10/1998-10/2010 and compared after a change in practice to miniAVR (6 cm incision, ministernotomy J'ed into 3rd right intercostal space, n = 147) from 11/2010-12/2013. Four patients had planned cAVR after 11/2010 because of concerns on preoperative imaging and are included in the cAVR group. A propensity score matching model was used to reduce the impact of confounding bias in this retrospective observational dataset.

Results

MiniAVR patients were older (mean age 70 vs. 66, p = 0.02) and had lower preoperative Hct (34% vs 38%, p < 0.001). There were more redo operations in the cAVR group (15% vs 8%, p = 0.03). There were no differences in other preoperative variables, including calculated STS mortality risk (3% miniAVR vs 4% cAVR). Operative/postoperative results are reported below (Table 1). There was no difference between groups in rate of stroke, MI, pneumonia, transfusion, inhospital mortality, 30 day mortality, and length of stay. Operative conversion rate to cAVR was 1%. There was a 26% absolute reduction in the rate of post-operative atrial fibrillation in the miniAVR group corresponding to a 64% relative risk reduction (p = 0.015). As expected, bypass and cross-clamp times were longer in the miniAVR group (CPB was 20 minutes longer, p = 0.002), XC was 24.5 min longer, p < 0.0001). Total chest tube drainage was decreased by nearly 300 mL (p < 0.0001).

Table 1

Variable

Effect Size

P>|z|

Atrial Fibrillation

-26.4%

0.015

MACCE

-8.2%

0.264

CPB (min)

20.0

0.002

XC (min)

24.5

<0.0001

CT Total Output (ml)

-295.8

<0.0001

In-hospital Mortality

-2.0%

0.396

30 day mortality

-1.4%

0.59

Stroke

-2.0%

0.587

Pneumonia

-4.8%

0.067

Takeback to OR

-1.4%

0.448

Intubation Time (hrs)

-2.4

0.2

Discussion/Conclusion

A dedicated change in practice to miniAVR is safe, associated with improved outcome, is favored by patients and referring providers and may be associated with a significant reduction in post-operative atrial fibrillation.

Authors’ Affiliations

(1)
The University of Vermont Medical Center, Burlington, VT, USA

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