Key result
Port-access aortic valve replacement significantly reduced postoperative hospital stay (11.1 vs 19.7 days) and blood transfusion requirements (30% vs 84%) compared to conventional surgery, though the port-access group was younger and had fewer comorbidities.
Why the study?
Does port-access aortic valve replacement improve perioperative outcomes compared to conventional midline sternotomy in patients with aortic valve disease?
Cohort (n=144)
No
Does port-access aortic valve replacement improve perioperative outcomes compared to conventional midline sternotomy in patients with aortic valve disease?
Absolute Event Rate: 11.1% vs 19.7%
p-value: p=<0.01
Port-access aortic valve replacement is a feasible alternative to conventional sternotomy, associated with faster recovery and reduced blood transfusion, though early results are confounded by selection bias toward lower-risk patients.
Port-access AVR was associated with shorter stays and fewer transfusions in lower-risk patients; leaves open benefits in randomized trials without selection bias.
BACKGROUND: In recent years, minimally invasive cardiac surgery has been developed. Thus far, only at our institute has port-access aortic valve replacement (PAVR) been performed in Japan. Herein we review our experiences with PAVR, and evaluate the surgical outcomes. METHODS AND RESULTS: Between May, 2007 and June, 2010, 37 cases of PAVR were performed. During the same period, 107 patients underwent conventional aortic valve replacement (CAVR) with midline sternotomy. Because we initially selected patients without high risk factors for PAVR, there were some differences in the preoperative demographic data between the CAVR and PAVR groups. Although cardiopulmonary bypass time and cross-clamp time were longer in the PAVR group (139 ± 28 vs. 113 ± 34 min; 97 ± 23 vs. 83 ± 24min), there were no significant differences in total operative time between both groups. With regard to the percentage of blood transfusion requirement, postoperative ventilation time, intensive care unit stay and hospital stay the PAVR group had significantly lower outcomes (11 vs. 90; 3.4 ± 1.9 h vs. 8.2 ± 16.3 h; 1.2 ± 0.6 days vs. 2.5 ± 1.7 days; 11.1 ± 4.3 days vs. 19.7 ± 7.8 days, respectively). There were no significant differences in mortality (1/37), and morbidity between both groups. CONCLUSIONS: PAVR a feasible treatment of choice for patients with aortic valve diseases complicated by various preoperative backgrounds.
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Hiraoka et al. (2011) conducted a cohort in Aortic valve disease requiring replacement (n=144). Port-access aortic valve replacement (PAVR) vs. Conventional aortic valve replacement (CAVR) was evaluated on Postoperative hospital stay (days) (p=<0.01). Port-access aortic valve replacement significantly reduced postoperative hospital stay (11.1 vs 19.7 days) and blood transfusion requirements (30% vs 84%) compared to conventional surgery, though the port-access group was younger and had fewer comorbidities.
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