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Ministernotomy reduces intubation time in aortic valve replacement with Perceval prosthesis
Journal of Cardiothoracic Surgery volume 10, Article number: A61 (2015)
Sutureless technology for aortic valve replacement (AVR) seems to reduce morbidity/mortality and minimally-invasive procedures are supposed to be facilitated. Consequently, even better results are expected from minimally-invasive surgery, but evidence of improvement is scarce.
To shed more light in this field, we studied the effect on hospital outcome of ministernotomy (MS) versus full sternotomy (FS) in AVR with Sorin Perceval.
From a single-center prospective registry (period 3/2011-2/2015), 104 patients underwent Perceval AVR without associated procedures. Three presented with absolute contraindications to MS and was discarded to favor a propensity score analysis. Accordingly, 67 with FS and 34 with a reversed-T MS were available. A logistic regression was performed and a nearest neighbor matching gave 24 couples.
Preoperative profile was similar in FS and MS: mean age 81+/-4.1 vs 81.2+/-4 (p = 0.91), BMI 27.4+/-5.5 vs 27.2+/-4.2 (p = 0.97), COPD 4.2% vs 4.2%, creatinine 0.97+/-0.31 vs 1+/-0.23 mg/dl (p = 0.38), diabetes 33.3% vs 41.7% (p = 0.77), EF 0.61 +/-0.11 vs 0.62+/-0.7 (p = 0.73), median frailty index 1 (IQR 0-3) vs 1 (IQR 0.5-2) (p = 0.65). FS assured faster operative times than MS: CPB 70.9+/-15.8 vs 86+/-16.5 (p = 0.002), cross-clamp 46.2+/-12.3 vs 58+/-12.6 min (p = 0.002). However, median intubation time was longer in FS (8 hours, 7-11) respect to MS (7 hours, 5-10.5) (p = 0.021). Hospital outcome did not differ: mortality 8.3% vs 0 (p = 0.49), re-exploration 4.2% vs 0 (p = 1), sternal dehiscence 4.2% vs 0 (p = 1), a-fib 45.8% vs 58.3% (p = 0.76), pacemaker 4.2% vs 8.3% (p = 1), median postop stay 6 vs 7 days (p = 0.23).
Although MS required longer CPB/cross-clamp times, intubation was shorter. Other clinical benefits from MS-AVR demands larger cohorts to be demonstrated.
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Villa, E., Messina, A., Tomba, M.D. et al. Ministernotomy reduces intubation time in aortic valve replacement with Perceval prosthesis. J Cardiothorac Surg 10, A61 (2015) doi:10.1186/1749-8090-10-S1-A61
- Propensity Score
- Aortic Valve Replacement
- Intubation Time
- Frailty Index
- Absolute Contraindication