Propensity matched analysis of minimally invasive versus conventional isolated aortic valve replacement

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.

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1269 Five Year Propensity Matched Outcomes of Minimally Invasive vs Conventional Isolated Aortic Valve Surgery

British Journal of Surgery ◽

10.1093/bjs/znab259.255 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

S Oo ◽

A Khan ◽

J Chan ◽

H Vohra

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Rank Test ◽

Valve Prosthesis ◽

Term Survival ◽

Operative Outcomes ◽

Significant Difference ◽

Aortic Valve Prosthesis

Abstract Aim To analyse the early and mid-term outcomes of the patients undergoing conventional isolated aortic valve replacement (CAVR) versus minimally invasive isolated aortic valve replacement (MIAVR). Method This is a single centre retrospective study involving 653 patients who underwent isolated aortic valve replacement either via CAVR (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 PM analysis showed the larger sized aortic valve prosthesis were inserted in the MIAVR group (22.8±2.5mm) compared to CAVR group (22.0±2.2mm)(p = 0.010). CPB time was longer with MIAVR (94.4±19.5mins) compared to CAVR (83.1 + 33.3; p = 0.003). 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 CAVR and MIAVR groups (17.3±8.2mmHg and13.0±5.1mmHg, respectively; p = 0.001). There was no significant difference between CAVR and MIAVR in the mid-term survival at 3 years. (log-rank test p = 0.314). Conclusions This study found that larger aortic valve sizes with lower mean gradients are being implanted in the MIAVR group. Despite the longer CPB time in the MIAVR group, there was no significant difference in the early complications, mortality, and mid-term survival between MIAVR and CAVR. Further studies will be required to analyse the long-term survival.

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Abstract 15741: Long Term Survival Following Transcatheter Aortic Valve Replacement: Results From a Single US High Volume Center

Circulation ◽

10.1161/circ.130.suppl_2.15741 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Ricardo O Escarcega ◽

Rebecca Torguson ◽

Marco A Magalhaes ◽

Nevin C Baker ◽

Sa’ar Minha ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Term Survival ◽

Transcatheter Aortic Valve ◽

Significant Difference ◽

Long Term Mortality

Introduction: Mortality following Transcatheter aortic valve replacement (TAVR) has been reported up to 5 years. However, mortality after 5 years remains unclear. Hypothesis: We aim to determine the mortality in patients undergoing TAVR >5 years follow up. Methods: From our institution’s prospectively collected TAVR database we analyzed all patients undergoing TAVR to a maximum follow up of 8 years. We divided our population into transapical TAVR (TA-TAVR) and transfemoral TAVR (TF-TAVR) groups. A Kaplan-Meier survival analysis was conducted. Results: A total of 511 patients who underwent TAVR were included in the analysis. Patients undergoing TA-TAVR had higher rates of peripheral vascular disease compared with TF-TAVR (56% vs 29%, p<0.001) and Society of Thoracic Surgeons Score (10.9 ± 4 vs 9.2 ± 4, p<0.001). TA-TAVR was associated with higher mortality at 1 year (32% vs 21%, p=0.01). However, there was no significant difference in very-long term mortality of patients undergoing TA-TAVR vs TF-TAVR (Figure). Conclusions: Long-term mortality following TAVR surpasses 50%. While in the first 2 years TA-TAVR is associated with higher mortality rates after three years the survival rates are similar in both approaches.

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Early Outcomes of Isolated Aortic Valve Replacement Through Right Anterior Minithoracotomy Using the Latest-Generation Biological Prosthesis

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984520975889 ◽

2020 ◽

pp. 155698452097588

Author(s):

Hossein Amirjamshidi ◽

Courtney Vidovich ◽

Ariana Goodman ◽

Peter A. Knight

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Effective Orifice Area ◽

Term Survival ◽

Invasive Approach ◽

Intermediate Outcomes ◽

Hemodynamic Performance

Objective The aim of this study is to evaluate early and intermediate outcomes and hemodynamics of the latest-generation Trifecta valve implanted using right anterior minithoracotomy. Methods We performed a single-center, retrospective, observational study including 175 individuals who underwent isolated minimally invasive aortic valve replacement with the latest-generation Trifecta valves through a right anterior minithoracotomy between January 2016 and January 2019. Exclusion criteria for follow-up echocardiographic study included concomitant procedures, conversion to median sternotomy, and nonsurvival during the index admission. Analyses addressed implantation safety, 30-day and intermediate-term survival and hemodynamic performance of the valves. Results Overall, patients were followed with duration ranging from 0.5 to 3 years. Early (<30 days) mortality occurred in 2 patients (1.1%), and there were 9 (5.1%) late (>30 days) deaths. Early thromboembolic events and postoperative bleeding requiring reoperation occurred at a rate of 4.0% ( n = 7) and 6.2% ( n = 11), respectively. Overall in 175 patients who met inclusion criteria for the follow-up echocardiography study, mean gradients across all valve sizes were 41.3 ± 14.9 (standard deviation) mm Hg preoperatively and remained low at 7.2 ± 3.9 mm Hg with mean effective orifice area of 1.8 ± 0.5 cm2 on the last follow-up echo. There was 1 case of infective prosthetic endocarditis, which did not require valve explant. There were no reoperations due to valve-related problems during the study period. Conclusions This is the largest series reporting on outcomes of the latest-generation Trifecta valve implanted using right anterior minithoracotomy. Our results demonstrate that this valve can be safely implanted via a minimally invasive approach with excellent early and intermediate outcomes and hemodynamic performance.

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Abstract 2865: Enhanced Left Ventricular Mass Regression Following Aortic Valve Replacement is Associated with Improved Long-Term Survival: A 15-year Study

Circulation ◽

10.1161/circ.118.suppl_18.s_788-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Ayyaz Ali ◽

Amit Patel ◽

Yasir Abu-Omar ◽

Anila Mehta ◽

Ziad Ali ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Ventricular ◽

Rank Test ◽

Actuarial Survival ◽

Term Survival ◽

Long Term Survival

Background Aortic valve replacement (AVR) is followed by regression of LVH. More complete resolution of LVH is suggested to be associated with superior clinical outcomes, however its impact on long-term survival following AVR has not been investigated. Methods Demographic and clinical data were obtained retrospectively through casenote review. Transthoracic echocardiography was used to measure LVM pre-operatively and at annual follow-up visits. Patients were grouped according to their reduction in LVM at late follow-up: Group A < 25 grams, Group B 25–150 grams and Group C > 150 grams. Results 211 patients underwent AVR between 1 st January 1991 and 1 st January 2001. Pre-operative LVM was 295 ± 118 g in A (n=63), 346 ± 97 g in B (n=75) and 539 ± 175 g in C (n=73), P <0.001. Mean time to last echocardiogram was 6.4 ± 3.3 years. LVM at late follow-up was 351 ± 160 g in A, 265 ± 95 g in B and 270 ± 90 g in C, P <0.001. Transvalvular gradients at follow-up were not significantly differerent between groups (A: 21 ± 21 mm Hg, B: 20 ± 15 mm Hg, C: 14 ± 11 mm Hg), P = 0.10. There was no difference in the prevalence of other factors influencing LVM regression such as IHD or hypertension. Ten year actuarial survival was significantly greater in patients with enhanced LVM regression when compared with the log-rank test (A: 49% ± 7, B: 67%± 6, C: 75% ± 6), P =0.03 (Figure 1 ). LVM reduction > 150 grams was an independent predictor of long-term survival on multivariate analysis (P = 0.03). Conclusion Enhanced LVM regression at late follow-up in patients undergoing AVR is associated with improved long-term survival. Strategies to optimize post-operative LVM regression should be considered in view of potential prognostic benefit.

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Minimally Invasive Transaortic Repair of the Mitral Valve

The Heart Surgery Forum ◽

10.1532/hsf98.20101133 ◽

2011 ◽

Vol 14 (4) ◽

pp. 232 ◽

Cited By ~ 2

Author(s):

Orlando Santana ◽

Joseph Lamelas

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Operative Mortality ◽

The Mean ◽

Transaortic Approach

Objective: We retrospectively evaluated the results of an edge-to-edge repair (Alfieri stitch) of the mitral valve performed via a transaortic approach in patients who were undergoing minimally invasive aortic valve replacement.Methods: From January 2010 to September 2010, 6 patients underwent minimally invasive edge-to-edge repair of the mitral valve via a transaortic approach with concomitant aortic valve replacement. The patients were considered to be candidates for this procedure if they were deemed by the surgeon to be high-risk for a double valve procedure and if on preoperative transesophageal echocardiogram the mitral regurgitation jet originated from the middle portion (A2/P2 segments) of the mitral valve.Results: There was no operative mortality. Mean cardiopulmonary bypass time was 137 minutes, and mean cross-clamp time was 111 minutes. There was a significant improvement in the mean mitral regurgitation grade, with a mean of 3.8 preoperatively and 0.8 postoperatively. The ejection fraction remained stable, with mean preoperative and postoperative ejection fractions of 43.3% and 47.5%, respectively. Follow-up transthoracic echocardiograms obtained at a mean of 33 days postoperatively (range, 8-108 days) showed no significant worsening of mitral regurgitation.Conclusion: Transaortic repair of the mitral valve is feasible in patients undergoing minimally invasive aortic valve replacement.

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Minimally Invasive Sutureless Aortic Valve Replacement is Associated With Improved Outcomes in Patients With Left Ventricular Dysfunction

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984519872990 ◽

2019 ◽

Vol 14 (5) ◽

pp. 445-452

Author(s):

Giovanni Concistrè ◽

Giacomo Bianchi ◽

Francesca Chiaramonti ◽

Rafik Margaryan ◽

Federica Marchi ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Lv Dysfunction ◽

The Impact

Objective Patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF) have a poor prognosis compared with patients with preserved LVEF. To evaluate the impact of sutureless Perceval (LivaNova, Italy) aortic bioprosthesis on LVEF and clinical outcomes in patients with baseline left ventricular (LV) dysfunction who underwent isolated aortic valve replacement (AVR). Methods Between March 2011 and August 2017, 803 patients underwent AVR with Perceval bioprosthesis implantation. Fifty-two isolated AVR had preoperative LVEF ≤45%. Mean age of these patients was 77 ± 6 years, 24 patients were female (46%), and mean EuroSCORE II was 9.4% ± 4.8%. Perceval bioprosthesis was implanted in 9 REDO operations. In 43 patients (83%), AVR was performed in minimally invasive surgery with an upper ministernotomy ( n = 13) or right anterior minithoracotomy ( n = 30). Results One patient died in hospital. Cardiopulmonary bypass and aortic cross-clamp times were 85.5 ± 26 minutes and 55.5 ± 19 minutes, respectively. At mean follow-up of 33 ± 20 months (range: 1 to 75 months), survival was 90%, freedom from reoperation was 100%, and mean transvalvular pressure gradient was 11 ± 5 mmHg. LVEF improved from 37% ± 7% preoperatively to 43% ± 8% at discharge ( P < 0.01) and further increased to 47% ± 9% at follow-up ( P = 0.06), LV mass decreased from 149.8 ± 16.9 g/m2 preoperatively to 115.3 ± 11.6 g/m2 at follow-up ( P < 0.001), and moderate paravalvular leakage occurred in 1 patient without hemolysis not requiring any treatment. Conclusions AVR with sutureless aortic bioprosthesis implantation in patients with preoperative LV dysfunction demonstrated a significant immediate and early improvement in LVEF.

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Early and long-term outcome of aortic valve replacement with homograft versus mechanical prosthesis-8-year follow-up study

Clinical Cardiology ◽

10.1002/clc.4960201010 ◽

1997 ◽

Vol 20 (10) ◽

pp. 843-848 ◽

Cited By ~ 7

Author(s):

Tomasz Waszyrowski ◽

JarosłAW D. Kasprzak ◽

Maria Krzemi Ńska-Pakuła ◽

Antoni Dziatkowiak ◽

Janusz ZasLonka

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Mechanical Prosthesis ◽

Term Outcome ◽

Long Term Outcome ◽

Follow Up Study

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Results of minimally invasive aortic valve replacement surgery through right thoracotomy at Hanoi Heart Hospital

Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam ◽

10.47972/vjcts.v35i.677 ◽

2021 ◽

Vol 35 ◽

pp. 56-66

Author(s):

Nguyen Sinh Hien ◽

Nguyen Minh Ngoc ◽

Nguyen Thai Minh ◽

Nguyen Dang Hung ◽

Dang Quang Huy ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Replacement Surgery ◽

Right Thoracotomy ◽

Early Results ◽

Heart Hospital ◽

Valve Replacement Surgery

Objectives: To evaluate results of minimally invasive aortic valve replacement surgery through right thoracotomy with some techinque improvements in Hanoi Heart Hospital. Methods: Surgery was performed via a small right thoracotomy in the second intercostal space. The third rib was detached by a wedge-shaped way using sternum saw. Cannulation approaches were central or peripheral depended on patients’ condition. Preoperative, perioperative, early results and follow-up data was collected and analysed. Results: There was 48 patients in the research. Mean age was 60,94 ± 11,53 (25-82), and 52,1% was male. 29,2% of patients had peripheral vascular disease. 22,9% underwent central arterial cannulation. 3 patients (6,3%) had pericardial adhesion. There was no early mortality, 2 patients had redo surgery due to excess bleeding. 1 patients had intestinal infarction. Mean follow-up time was 13,4 months. 91,3% of patients had NYHA I. 1 patients was dead due to intracerebral hemorrhage. Conclusions: With some improvements in techniques, minimally invasive aortic valve replacement surgery through right thoracotomy gave good early and midterm results in our center.

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Abstract 18908: Transcutaneous Aortic Valve Replacement - 30 Day and 1 Year Outcomes Using Conscious Sedation in Patients Stratified by STS Risk Score

Circulation ◽

10.1161/circ.130.suppl_2.18908 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Anitha Rajamanickam ◽

Sandeep Basnet ◽

Kaylan Mucci ◽

Ravinder Rao ◽

Jimmy Yee ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Conscious Sedation ◽

Statistical Significance ◽

Vascular Complications ◽

The Elderly ◽

Number Of Patients ◽

Significant Difference

Introduction: Transcutaneous Aortic Valve Replacement [TAVR] is usually performed under general anesthesia [GA]. We sought to examine the feasibility and safety of monitored conscious sedation [CS] as opposed to GA . METHODS: 196 patients [116 self expanding and 80 balloons expandable] underwent TAVR from December 2010 to August 2012 at our institution. 1 month follow up was completed on all patients and 1 year follow up was available on 105 patients. 39 patients [20%] underwent CS. Only one patient crossed over from CS to GA. We divided the patients into 3 groups [STS <8, STS of 8 to <12, STS ≥ 12 with the primary endpoints of all-cause mortality at 1 month and 1 year [See Table 1] RESULTS: Though the study did not meet statistical significance due to low number of patients, there was a trend towards improved mortality with CS. Also, there was no statically significant difference with regards to procedural complications including periprocedural MI, major bleeding, emergency CABG or major vascular complications. All 5 patients with periprocedural stroke had GA. The CS patients had a shorter length of stay [5 +2.87 days] as compared to GA patients [8 days+7.86 days] CONCLUSION: Use of CS suggested an improved mortality trend in higher risk patients [STS≥ 12]. This is of great importance as complications of GA, most importantly respiratory complications, are higher in the elderly TAVR patients and these can be avoided with CS . Also CS enables us to monitor neurological status during the procedure which is of vital importance given the high rates of stroke with TAVR

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A national study of the outcome after treatment of critical aortic stenosis in the neonate

Cardiology in the Young ◽

10.1017/s1047951120002036 ◽

2020 ◽

Vol 30 (9) ◽

pp. 1321-1327

Author(s):

Cecilia Kjellberg Olofsson ◽

Katarina Hanseus ◽

Jens Johansson Ramgren ◽

Mats Johansson Synnergren ◽

Jan Sunnegårdh

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Ventricular ◽

National Study ◽

Term Survival ◽

Critical Aortic Stenosis

AbstractObjective:This study describes short-term and long-term outcome after treatment of critical valvular aortic stenosis in neonates in a national cohort, with surgical valvotomy as first choice intervention.Methods:All neonates in Sweden treated for critical aortic stenosis between 1994 and 2016 were included. Patient files were analysed and cross-checked against the Swedish National Population Registry as of December 2017, giving complete survival data. Diagnosis was confirmed by reviewing echo studies. Critical aortic stenosis was defined as valvular stenosis with duct-dependent systemic circulation or depressed left ventricular function. Primary outcome was all-cause mortality and secondary outcomes were reintervention and aortic valve replacement.Results:Sixty-one patients were identified (50 boys, 11 girls). Primary treatment was surgical valvotomy in 52 neonates and balloon valvotomy in 6. Median age at initial treatment was 5 days (0–26), and median follow-up time was 10.8 years (0.14–22.6). There was no 30-day mortality but four late deaths. Freedom from reintervention was 66%, 61%, 54%, 49%, and 46% at 1, 5, 10, 15, and 20 years, respectively. Median time to reintervention was 3.4 months (4 days to 17.3 years). Valve replacement was performed in 23 patients (38%).Conclusions:Surgical valvotomy is a safe and reliable treatment in these critically ill neonates, with no 30-day mortality and long-term survival of 93% in this national study. At 10 years of age, reintervention was performed in 54% and at end of follow-up 38% had had an aortic valve replacement.

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