Why the study?
Minimally invasive approaches for aortic valve replacement are gaining popularity, but nationwide trends in approach selection and outcomes had not been analyzed.
Does minimally invasive aortic valve replacement improve perioperative outcomes compared to standard median sternotomy in patients undergoing isolated aortic valve replacement?
Observational (n=5,029)
Yes
Does minimally invasive aortic valve replacement improve perioperative outcomes compared to standard median sternotomy in patients undergoing isolated aortic valve replacement?
Minimally invasive aortic valve replacement is increasingly utilized in the Czech Republic, demonstrating low mortality and favorable perioperative recovery compared to full sternotomy.
Observational trends support wider minimally invasive AVR adoption where feasible; leaves open superiority over sternotomy in RCTs.
CĂl: MiniinvazivnĂ chirurgickĂŠ pĹĂstupy pro nĂĄhradu aortĂĄlnĂ chlopnÄ pĹedstavujĂ z hlediska invazivity kompromis mezi standardnĂ nĂĄhradou z mediĂĄnnĂ sternotomie a transkatĂŠtrovou implantacĂ aortĂĄlnĂ chlopnÄ. Popularitu si zĂskĂĄvajĂ dĂky pĹĂznivĂ˝m vĂ˝sledkĹŻm nedĂĄvnĂ˝ch studiĂ. CĂlem naĹĄĂ prĂĄce bylo provĂŠst analĂ˝zu volby a vĂ˝sledkĹŻ jednotlivĂ˝ch chirurgickĂ˝ch pĹĂstupĹŻ pro tuto operaci v poslednĂm pÄtiletĂ v ÄeskĂŠ republice. Metodika: Provedli jsme retrospektivnĂ analĂ˝zu vĹĄech izolovanĂ˝ch aortĂĄlnĂch chlopennĂch nĂĄhrad provedenĂ˝ch v ÄeskĂŠ republice v letech 2015-2019 z hlediska volby chirurgickĂŠho pĹĂstupu s vyuĹžitĂm dat z NĂĄrodnĂho registru kardiovaskulĂĄrnĂch operacĂ a intervencĂ. Hodnotili jsme poÄet pacientĹŻ a Äasnou perioperaÄnĂ mortalitu v jednotlivĂ˝ch skupinĂĄch v Äase a sumĂĄrnÄ i ÄasnĂŠ perioperaÄnĂ vĂ˝sledky pro jednotlivĂŠ pĹĂstupy. VĂ˝sledky: V Äase je jasnÄ vyjĂĄdĹena stoupajĂcĂ tendence k volbÄ miniinvazivnĂho pĹĂstupu pro nĂĄhradu aortĂĄlnĂ chlopnÄ. V roce 2019 bylo aĹž 287 pacientĹŻ (37,5 %) operovĂĄno miniinvazivnÄ (27,6 % z parciĂĄlnĂ sternotomie a 9,3 % z torakotomie, v 0,6 % byla nutnĂĄ konverze na sternotomii) pĹi zachovĂĄnĂ stabilnÄ nĂzkĂŠ mortality a rizika konverze. Pacienti operovanĂ miniinvazivnÄ mÄli kratĹĄĂ operaÄnĂ Äasy, kratĹĄĂ dobu intubace a dobu pobytu na jednotce intenzivnĂ pĂŠÄe, niŞťà krevnĂ ztrĂĄty a spotĹebu transfuznĂch pĹĂpravkĹŻ, niŞťà riziko konverze i rannĂŠ infekce. Dle EuroSCORE II se vĹĄak jednalo o mĂĄlo rizikovĂŠ pacienty. ZĂĄvÄry: V ÄeskĂŠ republice je jasnÄ vyjĂĄdĹen pĹĂznivĂ˝ trend ke stoupajĂcĂmu vyuĹžitĂ miniinvazivnĂch pĹĂstupĹŻ pro izolovanou nĂĄhradu aortĂĄlnĂ chlopnÄ pĹi zachovĂĄnĂ nĂzkĂŠ mortality. Pacienti operovanĂ miniinvazivnÄ vykazujĂ nĂzkĂŠ riziko komplikacĂ a rychlou rekonvalescenci. Pro chirurgickou nĂĄhradu aortĂĄlnĂ chlopnÄ by mÄl bĂ˝t preferenÄnÄ volen miniinvazivnĂ pĹĂstup, pokud nejsou zĂĄsadnĂ kontraindikace.
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Gofus et al. (2020) conducted an observational in Aortic valve stenosis requiring isolated surgical replacement (n=5,029). Minimally invasive surgical approaches (partial sternotomy, thoracotomy) vs. Standard median sternotomy was evaluated on Early perioperative mortality and trend of surgical approach choice.
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