Conventional or minimally invasive aortic valve replacement: Perioperative and 3-year outcomes

Introduction Ministernotomy (MS) is a minimally invasive approach for aortic valve replacement which aims to reduce operative trauma and enhance recovery. However, the impact of MS on perioperative mortality and long-term survival remains debated. Thus, the propose of our study was to compare the outcomes of AVR performed through FS versus MS, to determine which approach offers better results in terms of mortality, recovery, safety, and long-term survival. Methods The present study is a retrospective analysis of patients who underwent isolated AVR from 2014 (year in which the first AVR trough MS was performed) to 2023 at our institution. Statistical adjustment for treatment intervention (MS) was performed by estimating the propensity score with inverse probability weighting. Results 30-Day mortality occurred in 0.39% in the MS group and 1.63% in the FS group (adjusted RD: −0.014; 95% CI: −0.029, 0.001; p = 0.080). Survival analysis at 3-year follow-up revealed no significant differences in the HR between groups (92.5% vs 90.4%; HR: 0.78; 95% CI: 0.40, 1.54; p = 0.479). We observed a significant risk reduction in the MS group for sternal wound infection (adjusted RD: −0.021; 95% CI: −0.039, 0.003; p = 0.024), Intubation time (adjusted RD: −8.80; 95% CI: −15.04, −2.56; p = 0.024), postoperative bleeding (adjusted RD: −0.037; 95% CI: −0.074, −0.001; p = 0.049) and stage 4 AKI (adjusted RD: −0.016; 95% CI: −0.031, −0.001; p = 0.032). Conclusion In a retrospective, single-center study, AVR through MS presented no significant differences compared to FS regarding 30-day mortality and 3-year survival. MS was associated with a significantly lower risk for postoperative DSWI, wound dehiscence, bleeding requiring reintervention, AKI requiring renal replacement therapy and a significantly shorter intubation time.