Key result
Minimally invasive AVR shows no 3-year survival benefit over conventional AVR.
Why the study?
The study was conducted to analyse the early and mid-term outcomes of patients undergoing conventional aortic valve replacement compared with minimally invasive aortic valve replacement via hemi-sternotomy.
Does minimally invasive via hemi-sternotomy aortic valve replacement improve early and mid-term outcomes compared to conventional aortic valve replacement in patients undergoing isolated aortic valve replacement?
Cohort (n=653)
No
Does minimally invasive via hemi-sternotomy aortic valve replacement improve early and mid-term outcomes compared to conventional aortic valve replacement in patients undergoing isolated aortic valve replacement?
Absolute Event Rate: 92.1% vs 88.6%
p-value: p=0.31
Minimally invasive aortic valve replacement via hemi-sternotomy provides comparable mid-term survival and early outcomes to conventional AVR, despite longer cardiopulmonary bypass and cross-clamp times.
Comparable survival in this cohort should not change practice; leaves open advantages of minimally invasive AVR in randomized trials.
Objective: To analyse the early and mid-term outcome of patients undergoing conventional aortic valve replacement (AVR) versus minimally invasive via hemi-sternotomy aortic valve replacement (MIAVR). Methods: A single centre retrospective study involving 653 patients who underwent isolated aortic valve replacement (AVR) either via conventional AVR ( n = 516) or MIAVR ( n = 137) between August 2015 and March 2020. Using pre-operative characteristics, patients were propensity matched (PM) to produce 114 matched pairs. Assessment of peri-operative outcomes, early and mid-term survival and echocardiographic parameters was performed. Results: The mean age of the PM conventional AVR group was 71.5 (±8.9) years and the number of male ( n = 57) and female ( n = 57) patients were equal. PM MIAVR group mean age was 71.1 (±9.5) years, and 47% of patients were female ( n = 54) and 53% male ( n = 60). Median follow-up for PM conventional AVR and MIAVR patients was 3.4 years (minimum 0, maximum 4.8 years) and 3.4 years (minimum 0, maximum 4.8 years), respectively. Larger sized aortic valve prostheses were inserted in the MIAVR group (median 23, IQR = 4) versus conventional AVR group (median 21, IQR = 2; p = 0.02, SMD = 0.34). Cardiopulmonary bypass (CPB) time was longer with MIAVR (94.4 ± 19.5 minutes) compared to conventional AVR (83.1 ± 33.3; p = 0.0001, SMD = 0.41). Aortic cross-clamp (AoX) time was also longer in MIAVR (71.6 ± 16.5 minutes) compared to conventional AVR (65.0 ± 52.8; p = 0.0001, SMD = 0.17). There were no differences in the early post-operative complications and mortality between the two groups. Follow-up echocardiographic data showed significant difference in mean aortic valve gradients between conventional AVR and MIAVR groups (17.3 ± 8.2 mmHg vs 13.0 ± 5.1 mmHg, respectively; p = 0.01, SMD = −0.65). There was no significant difference between conventional AVR and MIAVR in mid-term survival at 3 years (88.6% vs 92.1%; log-rank test p = 0.31). Conclusion: Despite the longer CPB and AoX times in the MIAVR group, there was no significant difference in early complications, mortality and mid-term survival between MIAVR and conventional AVR.
No takes yet. Share an insight, caveat, or question.
Oo et al. (2021) conducted a cohort in Isolated aortic valve replacement (n=653). Minimally invasive via hemi-sternotomy aortic valve replacement (MIAVR) vs. Conventional aortic valve replacement (AVR) was evaluated on Mid-term survival at 3 years (p=0.31). Minimally invasive aortic valve replacement showed no significant difference in mid-term survival at 3 years compared to conventional AVR (92.1% vs 88.6%; P=0.31).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: