Outcomes Amongst Obesity Class I, II, and III Patients Undergoing Minimally Invasive Aortic Valve Replacement

Background: Minimally invasive heart valve surgery has previously been shown to be safe and feasible in obese patients. Within this population, we investigated the effect of obesity class on the patient outcomes of minimally invasive aortic valve replacement (mini-AVR). Methods: A single center retrospective cohort study of consecutive patients with obese body mass indices (BMIs) who underwent mini-AVR between 2012 and 2018. Patients were stratified into 3 groups according to Centers for Disease Control and Prevention adult obesity classifications: Class I (BMI 30.0 to < 35.0), Class II (BMI 35.0 to < 40.0), and Class III (BMI ≥ 40.0). The primary outcomes were postoperative length of stay (LOS), 30-day mortality within, and cost. Results: Amongst 182 obese patients who underwent mini-AVR, LOS (Class I 4 [3-6] vs. Class II 4 [3-6] vs. Class III 5 [4-6] days; p=0.098) and costs (Class I $24,487 [$20,199-$27.480] vs. Class II $22,921 [$20,433-$27,740] vs. Class III $23,886 [$20,063-$33,800] USD; p=0.860) did not differ between obesity class cohorts. Postoperative 30-day mortality (Class I 2.83% [n=2] vs. Class II 0% [n=0] vs. Class III 0% [n=0]; p=0.763) was limited by an insufficient sample size relative to a low event rate but did not differ between patient cohorts. Conclusions: Mini-AVR is safe and feasible to perform for obese patients regardless of their obesity class. Patients with obesity should be afforded the option of minimally invasive aortic valve surgery regardless of their obesity class.

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Minimally invasive sutureless and rapid deployment aortic valve replacement: the new benchmark for aortic valve surgery?

Annals of Cardiothoracic Surgery ◽

10.21037/acs-2019-surd-175 ◽

2020 ◽

Vol 9 (4) ◽

pp. 328-329

Author(s):

Francesco Pollari ◽

Theodor Fischlein

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Rapid Deployment

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Traversing the learning curve in minimally invasive heart valve surgery: a cumulative analysis of an individual surgeon's experience with a right minithoracotomy approach for aortic valve replacement

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezr230 ◽

2012 ◽

Vol 41 (6) ◽

pp. 1242-1246 ◽

Cited By ~ 53

Author(s):

M. Murzi ◽

A. G. Cerillo ◽

S. Bevilacqua ◽

D. Gilmanov ◽

P. Farneti ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Learning Curve ◽

Valve Replacement ◽

Heart Valve ◽

Valve Surgery ◽

Heart Valve Surgery

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Low-Computational Cost Stitching Method in a Three-Eyed Endoscope

Journal of Healthcare Engineering ◽

10.1155/2019/5613931 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12

Author(s):

Virginia Mamone ◽

Sara Condino ◽

Fabrizio Cutolo ◽

Izadyar Tamadon ◽

Arianna Menciassi ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Computational Cost ◽

Valve Surgery ◽

Definitive Treatment ◽

Wide Field ◽

Aortic Valve Surgery ◽

Image Size

Aortic valve replacement is the only definitive treatment for aortic stenosis, a highly prevalent condition in elderly population. Minimally invasive surgery brought numerous benefits to this intervention, and robotics recently provided additional improvements in terms of telemanipulation, motion scaling, and smaller incisions. Difficulties in obtaining a clear and wide field of vision is a major challenge in minimally invasive aortic valve surgery: surgeon orientates with difficulty because of lack of direct view and limited spaces. This work focuses on the development of a computer vision methodology, for a three-eyed endoscopic vision system, to ease minimally invasive instrument guidance during aortic valve surgery. Specifically, it presents an efficient image stitching method to improve spatial awareness and overcome the orientation problems which arise when cameras are decentralized with respect to the main axis of the aorta and are nonparallel oriented. The proposed approach was tested for the navigation of an innovative robotic system for minimally invasive valve surgery. Based on the specific geometry of the setup and the intrinsic parameters of the three cameras, we estimate the proper plane-induced homographic transformation that merges the views of the operatory site plane into a single stitched image. To evaluate the deviation from the image correct alignment, we performed quantitative tests by stitching a chessboard pattern. The tests showed a minimum error with respect to the image size of 0.46 ± 0.15% measured at the homography distance of 40 mm and a maximum error of 6.09 ± 0.23% at the maximum offset of 10 mm. Three experienced surgeons in aortic valve replacement by mini-sternotomy and mini-thoracotomy performed experimental tests based on the comparison of navigation and orientation capabilities in a silicone aorta with and without stitched image. The tests showed that the stitched image allows for good orientation and navigation within the aorta, and furthermore, it provides more safety while releasing the valve than driving from the three separate views. The average processing time for the stitching of three views into one image is 12.6 ms, proving that the method is not computationally expensive, thus leaving space for further real-time processing.

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Minimally Invasive Endoscopic Aortic Valve Replacement in Morbidly Obese Patients: Early Results

Structural Heart ◽

10.1080/24748706.2020.1715151 ◽

2020 ◽

Vol 4 (sup1) ◽

pp. 71-71

Author(s):

Giovanni Domenico Cresce ◽

Tommaso Hinna Danesi ◽

Massimo Sella ◽

Emad Al Jaber ◽

Alessandro Favaro ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Morbidly Obese ◽

Obese Patients ◽

Early Results

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Improved Patient Recovery With Minimally Invasive Aortic Valve Surgery: A Propensity-Matched Study

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984519868715 ◽

2019 ◽

Vol 14 (5) ◽

pp. 419-427 ◽

Cited By ~ 1

Author(s):

Piergiorgio Bruno ◽

Federico Cammertoni ◽

Raphael Rosenhek ◽

Andrea Mazza ◽

Natalia Pavone ◽

...

Keyword(s):

Aortic Valve ◽

Blood Loss ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Assisted Ventilation ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Hospital Stays ◽

Matched Study

Objective Despite conflicting evidence available, minimally invasive aortic valve replacement (MIAVR) is increasingly used as an alternative to full sternotomy. We sought to compare early outcomes of aortic valve replacement through a full sternotomy (conventional aortic valve replacement [CAVR]) and upper ministernotomy (MIAVR). Methods We analyzed 297 patients having undergone primary, elective, isolated MIAVR or CAVR between January 2014 and June 2018. Following propensity score matching, 120 patients remained in each group. Results MIAVR required longer bypass (93 ± 26 vs 81 ± 24 minutes, P < 0.01) and operative times (214 ± 39 vs 182 ± 37 minutes, P < 0.01). However, aortic cross-clamp times were comparable (57 ± 17 vs 54 ± 14 minutes for MIAVR and CAVR, respectively, P = 0.14). MIAVR had less 24-hour blood loss (253 ± 204 vs 323 ± 296 mL, P = 0.03), less red blood cells transfusions [1.4 packs (1.1 o 1.9) vs 2.1 packs (1.8 to 2.7), P = 0.01], and shorter assisted ventilation time (7.1 ± 3.3 vs 9.7 ± 3.8 hours, P < 0.01) when compared to CAVR. These results led to significantly shorter intensive care unit and hospital stays for MIAVR patients (2.5 ± 1.3 vs 3.4 ± 1.1 days, P < 0.01 and 6.9 ± 4.1 vs 8.2 ± 4.8 days, P = 0.03, respectively). Thirty-day mortality and clinical outcomes did not differ significantly among groups. Conclusions MIAVR through upper ministernotomy was shown to be as safe and reliable as CAVR. Patient recovery time was improved by shortening mechanical ventilation and reducing blood loss and transfusions. These results may be significant for high-risk patients undergoing aortic valve surgery.

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Minimally Invasive Aortic Valve Surgery in Octogenarians: Reliable Option or Fallback Solution?

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984520974467 ◽

2020 ◽

pp. 155698452097446

Author(s):

Federico Cammertoni ◽

Piergiorgio Bruno ◽

Raphael Rosenhek ◽

Natalia Pavone ◽

Piero Farina ◽

...

Keyword(s):

Mechanical Ventilation ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Valve Surgery ◽

Chest Drain ◽

Blood Transfusions ◽

Aortic Valve Surgery ◽

Term Survival

Objective Aortic valve disease is more and more common in western countries. While percutaneous approaches should be preferred in older adults, previous reports have shown good outcomes after surgery. Moreover, advantages of minimally invasive approaches may be valuable for octogenarians. We sought to compare outcomes of conventional aortic valve replacement (CAVR) versus minimally invasive aortic valve replacement (MIAVR) in octogenarians. Methods We retrospectively collected data of 75 consecutive octogenarians who underwent primary, elective, isolated aortic valve surgery through conventional approach (41 patients, group CAVR) or partial upper sternotomy (34 patients, group MIAVR). Results Mean age was 81.9 ± 0.9 and 82.3 ± 1.1 years in CAVR and MIAVR patients, respectively ( P = 0.09). MIAVR patients had lower 24-hour chest drain output (353.4 ± 207.1 vs 501.7 ± 229.9 mL, P < 0.01), shorter mechanical ventilation (9.6 ± 2.4 vs 11.3 ± 2.3 hours, P < 0.01), lower need for blood transfusions (35.3% vs 63.4%, P = 0.02), and shorter hospital stay (6.8 ± 1.6 vs 8.3 ± 4.3 days, P < 0.01). Thirty-day mortality was zero in both groups. Survival at 1, 3, and 5 years was 89.9%, 80%, and 47%, respectively, in the CAVR group, and 93.2%, 82.4%, and 61.8% in the MIAVR group, with no statistically significant differences (log-rank test, P = 0.35). Conclusions Aortic valve surgery in older patients provided excellent results, as long as appropriate candidates were selected. MIAVR was associated with shorter mechanical ventilation, reduced blood transfusions, and reduced hospitalization length, without affecting perioperative complications or mid-term survival.

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