Full sternotomy and minimal access approaches for surgical aortic valve replacement: a multicentre propensity-matched study

Abstract OBJECTIVES Surgical aortic valve replacement (AVR) can be performed via a full sternotomy or a minimal access approach (mini-AVR). Despite long-term experience with the procedure, mini-AVR is not routinely adopted. Our goal was to compare contemporary outcomes of mini-AVR and conventional AVR in a large multi-institutional national cohort. METHODS A total of 5801 patients from 10 different centres who had a mini-AVR (2851) or AVR (2950) from 2011 to 2017 were evaluated retrospectively. Standard aortic prostheses were used in all cases. The use of the minimally invasive approach has increased over the years. The primary outcome is the incidence of 30-day deaths following mini-AVR and AVR. Secondary outcomes are the occurrence of major complications following both procedures. Propensity-matched comparisons were performed based on the multivariable logistic regression model. RESULTS In the overall population patients who had AVR had an increased surgical risk based on the EuroSCORE, and the 30-day mortality rate was higher (1.5% and 2.3% in mini-AVR and AVR, respectively; P = 0.048). Propensity scores identified 2257 patients per group with similar baseline profiles. In the matched groups, patients who had mini-AVR, despite longer cardiopulmonary bypass (81 ± 32 vs 76 ± 28 min; P = 0.004) and cross-clamp (64 ± 24 vs 59 ± 21 min; P ≤ 0.001) times, had lower 30-day mortality rates (1.2% vs 2.0%; P = 0.036), reduced low cardiac output (0.8% vs 1.4%; P = 0.046) and reduced postoperative length of stay (9 ± 8 vs 10 ± 7 days; P = 0.004). Blood transfusions (36.4% vs 30.8%; P ≤ 0.001) and atrial fibrillation (26.0% vs 21.5%, P ≤ 0.001) were higher in patients who had the mini-AVR. CONCLUSIONS In a large multi-institutional recent cohort, minimal access approach aortic valve replacement is associated with reduced 30-day mortality rates and shorter postoperative lengths of stay compared to standard sternotomy. A prospective randomized trial is needed to overcome the possible biases of a retrospective study.

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TCT CONNECT-84 Transcatheter and Surgical Aortic Valve Replacement in Kidney Transplant Recipients: Insights From a National Cohort (2011 to 2017)

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2020.09.098 ◽

2020 ◽

Vol 76 (17) ◽

pp. B37-B38

Author(s):

Catherine Williamson ◽

Esteban Aguayo ◽

Vishal Dobaria ◽

Joseph Hadaya ◽

Yas Sanaiha ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Kidney Transplant ◽

Valve Replacement ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Surgical Aortic Valve Replacement ◽

National Cohort

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Meta‐Analysis of Stroke and Mortality Rates in Patients Undergoing Valve‐in‐Valve Transcatheter Aortic Valve Replacement

Journal of the American Heart Association ◽

10.1161/jaha.120.019512 ◽

2021 ◽

Vol 10 (6) ◽

Author(s):

Sascha Macherey ◽

Max Meertens ◽

Victor Mauri ◽

Christian Frerker ◽

Matti Adam ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Mortality Rates ◽

Heart Team ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Valve In Valve ◽

Bioprosthetic Valves

Background During the past decade, the use of transcatheter aortic valve replacement (TAVR) was extended beyond treatment‐naïve patients and implemented for treatment of degenerated surgical bioprosthetic valves. Selection criteria for either valve‐in‐valve (viv) TAVR or redo surgical aortic valve replacement are not well established, and decision making on the operative approach still remains challenging for the interdisciplinary heart team. Methods and Results This review was intended to analyze all studies on viv‐TAVR focusing on short‐ and mid‐term stroke and mortality rates compared with redo surgical aortic valve replacement or native TAVR procedures. A structured literature search and review process led to 1667 potentially relevant studies on July 1, 2020. Finally, 23 studies fulfilled the inclusion criteria for qualitative analysis. All references were case series either with or without propensity score matching and registry analyses. Quantitative synthesis of data from 8509 patients revealed that viv‐TAVR is associated with mean 30‐day stroke and mortality rates of 2.2% and 4.2%, respectively. Pooled data analysis showed no significant differences in 30‐day stroke rate, 30‐day mortality, and 1‐year mortality between viv‐TAVR and comparator treatment (native TAVR [n=11 804 patients] or redo surgical aortic valve replacement [n=498 patients]). Conclusions This review is the first one comparing the risk for stroke and mortality rates in viv‐TAVR procedures with native TAVR approach and contributes substantial data for the clinical routine. Moreover, this systematic review is the most comprehensive analysis on ischemic cerebrovascular events and early mortality in patients undergoing viv‐TAVR. In this era with increasing numbers of bioprosthetic valves used in younger patients, viv‐TAVR is a suitable option for the treatment of degenerated bioprostheses.

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Surgical aortic valve replacement and patient–prosthesis mismatch: a meta-analysis of 108 182 patients

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezy466 ◽

2019 ◽

Vol 56 (1) ◽

pp. 44-54 ◽

Cited By ~ 10

Author(s):

Michel Pompeu Barros de Oliveira Sá ◽

Martinha Millianny Barros de Carvalho ◽

Dário Celestino Sobral Filho ◽

Luiz Rafael Pereira Cavalcanti ◽

Sérgio da Costa Rayol ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Mortality Rates ◽

Surgical Aortic Valve Replacement ◽

Perioperative Mortality ◽

Patient Prosthesis Mismatch ◽

The Impact ◽

Long Term Mortality

Abstract OBJECTIVES This study sought to evaluate the impact of patient–prosthesis mismatch (PPM) on the risk of perioperative, early-, mid- and long-term mortality rates after surgical aortic valve replacement. METHODS Databases were searched for studies published until March 2018. The main outcomes of interest were perioperative mortality, 1-year mortality, 5-year mortality and 10-year mortality. RESULTS The search yielded 3761 studies for inclusion. Of these, 70 articles were analysed, and their data were extracted. The total number of patients included was 108 182 who underwent surgical aortic valve replacement. The incidence of PPM after surgical aortic valve replacement was 53.7% (58 116 with PPM and 50 066 without PPM). Perioperative mortality [odds ratio (OR) 1.491, 95% confidence interval (CI) 1.302–1.707; P < 0.001], 1-year mortality (OR 1.465, 95% CI 1.277–1.681; P < 0.001), 5-year mortality (OR 1.358, 95% CI 1.218–1.515; P < 0.001) and 10-year mortality (OR 1.534, 95% CI 1.290–1.825; P < 0.001) were increased in patients with PPM. Both severe PPM and moderate PPM were associated with increased risk of perioperative mortality, 1-year mortality, 5-year mortality and 10-year mortality when analysed together and separately, although we observed a higher risk in the group with severe PPM. CONCLUSIONS Moderate/severe PPM increases perioperative, early-, mid- and long-term mortality rates proportionally to its severity. The findings of this study support the implementation of surgical strategies to prevent PPM in order to decrease mortality rates.

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