Key result
Mini-AVR linked to ~67% lower postoperative AF risk and shorter hospital stays versus sternotomy.
Why the study?
With increasing demand for minimally invasive aortic valve replacement, the study investigated the safety and feasibility of Mini-AVR through a right parasternal second intercostal transverse incision.
Does minimally invasive aortic valve replacement through a right parasternal second intercostal transverse incision improve perioperative outcomes compared to sternotomy in patients undergoing isolated aortic valve replacement?
Cohort (n=111)
No
Does minimally invasive aortic valve replacement through a right parasternal second intercostal transverse incision improve perioperative outcomes compared to sternotomy in patients undergoing isolated aortic valve replacement?
Absolute Event Rate: 10.2% vs 30.6%
p-value: p=< 0.05
Minimally invasive aortic valve replacement via a right parasternal second intercostal transverse incision is safe, feasible, and associated with faster recovery and fewer complications than conventional sternotomy.
May reduce postoperative AF and hospital stay after isolated AVR; extends observational data but leaves open need for RCTs.
BACKGROUND: There is an increasing demand for minimally invasive aortic valve replacement. This study aimed to investigate the safety and feasibility of minimally invasive aortic valve replacement through a right parasternal second intercostal transverse incision. METHODS: This was a retrospective study, and we collected information from 111 patients who underwent isolated aortic valve replacement surgery performed by the same surgeon from January 2018 to December 2019. According to the operative approach, the patients were divided into a sternotomy aortic valve replacement (SAVR) group (n = 62) and a minimally invasive aortic valve replacement (Mini-AVR) group (n = 49). We compared the intraoperative and postoperative data between the two groups. RESULT: There was no difference in preoperative data between the Mini-AVR and SAVR. The postoperative ventilator-assisted time, CSICU time and postoperative hospital stay of the Mini-AVR were shorter than those of the SAVR [(15.45 ± 5.75) VS (18.51 ± 6.71) h; (1.77 ± 0.31) VS (2.04 ± 0.63) d; (8.69 ± 2.75) VS (10.77 ± 2.94) d], and the difference was statistically significant (P < 0.05). Mini-AVR had lower postoperative drainage and blood transfusion rates in the first 24 h than SAVR [(109.86 ± 125.98) VS (508.84 ± 311.70) ml; 22.4% VS 46.8%], and the differences were statistically significant (P < 0.05). The incidence of postoperative AF in the Mini-AVR group was also lower than that in the SAVR group (10.2% VS 30.6%), and the differences were statistically significant (P < 0.05). CONCLUSION: Mini-AVR has the advantages of less ventilator time, a reduced need for blood transfusion, less AF and a faster recovery. Mini-AVR is a safe and feasible surgical technique that is worthy of clinical application.
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Lü et al. (2021) conducted a cohort in Isolated aortic valve replacement (n=111). Minimally invasive aortic valve replacement (Mini-AVR) vs. Sternotomy aortic valve replacement (SAVR) was evaluated on Postoperative atrial fibrillation (AF) (p=< 0.05). Minimally invasive aortic valve replacement was associated with a lower incidence of postoperative atrial fibrillation (10.2% vs 30.6%, P<0.05) and shorter hospital stay compared to sternotomy.
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