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  • Meeting abstract
  • Open Access

Ministernotomy reduces intubation time in aortic valve replacement with Perceval prosthesis

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Journal of Cardiothoracic Surgery201510 (Suppl 1) :A61

https://doi.org/10.1186/1749-8090-10-S1-A61

  • Published:

Keywords

  • Propensity Score
  • Aortic Valve Replacement
  • Intubation Time
  • Frailty Index
  • Absolute Contraindication

Background/Introduction

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.

Aims/Objectives

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.

Method

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.

Results

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).

Discussion/Conclusion

Although MS required longer CPB/cross-clamp times, intubation was shorter. Other clinical benefits from MS-AVR demands larger cohorts to be demonstrated.

Authors’ Affiliations

(1)
Cardiac Surgery, Poliambulanza Foundation Hospital, Brescia, 25124, Italy
(2)
Catholic University, Rome, 00168, Italy

Copyright

© Villa et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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