Immediate and Long-Term Results of Minimally Invasive Aortic Valve Replacement: Single Center Retrospective Study

Highlights We have conducted a retrospective analysis of patients who underwent minimally invasive aortic valve replacement, and evaluated immediate and long-term results of the surgery. Abstract Aim. To study the immediate and long-term results of minimally invasive aortic valve (AV) replacement. Methods. The retrospective study included 208 patients with AV stenosis undergoing minimally invasive aortic valve replacement in the period from 2010 to 2019. The ratio of men to women was 1:1. The mean age of the patients was 63 (58–68) years old, with the minimum age being 29 years and the maximum being 81 years. The median follow-up period was 45.5 (11–68) months. Endpoints were as follows: hospital mortality, postoperative complications, long-term outcome (long-term survival, freedom from reoperation). Inclusion criteria were as follows: patients aged 18 years and older undergoing minimally invasive aortic valve replacement. Exclusion criteria were as follows: AVNeo, Ross procedure and AV replacement with aortic homograft, combined interventions (except for intervention on the ascending aorta), and standard access site. Results. The majority of patients (199 (95.7%) underwent “J”-shaped ministernotomy through the III-IV intercostal space. As a part of the combined intervention, ascending aorta replacement was performed in 6 (2.9%) patients. The duration of cardiopulmonary bypass and aortic cross-clamping was 91 (78–106) min and 68 (60–78) min, respectively. Due to conduction disorders, implantation of a pacemaker was performed in 5 (2.4%) patients, stroke was diagnosed in 1 (0.5%) patient, resternotomy for bleeding was performed in 4 (1.9%) patients, cardiac tamponade in 2 (1 %) patients, sternal infection was found in 1 (0.5%) patient. There were no complications such as AKI, perioperative MI, or hospital mortality in any patient. Five- and ten-year survival after surgical treatment of patients was 88.2% and 80.5%, respectively. Five- and ten-year freedom from reoperation on AV was 96.2% and 96.2%. Conclusions. Minimally invasive AV replacement is a measurable procedure with negligible complication rates. Minimally invasive aortic valve replacement has shown its effectiveness in the long-term period with acceptable rates of survival and freedom from reoperation.