scholarly journals Outcomes of the minimally invasive aortic valve replacement

2019 ◽  
Vol 178 (3) ◽  
pp. 16-20
Author(s):  
M. A. Snegirev ◽  
A. A. Paivin ◽  
D. O. Denisyuk ◽  
N. E. Khvan ◽  
L. B. Sichinava ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Early Postoperative Period ◽  
Red Blood Cell Transfusion ◽  
Postoperative Blood Loss ◽  
Transfusion Rate ◽  
Results Of Treatment ◽  
Risk Patients

The OBJECTIVE was to demonstrate clinical outcomes of minimally invasive aortic valve replacement (MIAVR).MATERIAL AND METHODS. We retrospectively analyzed surgical results of treatment of patients underwent isolated AVR in our Institution between 2006 and 2018. Overall number of operations was 122; 56 of patient were operated via upper ministernotomy approach. Preoperative characteristics were similar in both groups.RESULTS. In our series MIAVR procedures had prolonged CPB and aortic cross clamping time, what significantly contributed to the increase in manifestations of heart failure in the early postoperative period, but didn’t affect the perioperative mortality and major morbidity rates. MIAVR led to reduction in postoperative blood loss and perioperative red blood cell transfusion rate. Most severe complications occurred in frail patients older than 75 years, and in those with extensive aortic annular calcification.CONCLUSION. MIAVR was the safe and reproducible surgical intervention and rarely led to significant complications in low-risk patients. Prolonged CPB time adversely affected the frequency of significant complications, especially in elderly patients. Although, selected high risk patients might benefit with MIAVR.

CURRENT SURGICAL RISK SCORES OVERESTIMATE THE RISK ASSOCIATED WITH MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT IN LOW-RISK PATIENTS

2019 ◽  
Vol 73 (9) ◽  
pp. 1967
Author(s):  
Ahmed Alnajar ◽  
Subhasis Chatterjee ◽  
Brenden Chou ◽  
Mariam Khabsa ◽  
Madeline Rippstein ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Low Risk ◽  
Risk Scores ◽  
Surgical Risk ◽  
Risk Patients

Respiratory System Function in Patients after Minimally Invasive Aortic Valve Replacement Surgery

2017 ◽  
Vol 12 (2) ◽  
pp. 127-136 ◽  
Author(s):  
Jarosław Stoliński ◽  
Robert Musiał ◽  
Dariusz Plicner ◽  
Janusz Andres
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Functional Status ◽  
Valve Replacement ◽  
Respiratory System ◽  
Lung Ventilation ◽  
Postoperative Blood Loss ◽  
System Function ◽  
Mechanical Lung Ventilation

Objective The aim of the study was to comparatively analyze respiratory system function after minimally invasive, through right minithoracotomy aortic valve replacement (RT-AVR) to conventional AVR. Methods Analysis of 201 patients scheduled for RT-AVR and 316 for AVR between January 2010 and November 2013. Complications of the respiratory system and pulmonary functional status are presented. Results Complications of the respiratory system occurred in 16.8% of AVR and 11.0% of RT-AVR patients ( P = 0.067). The rate of pleural effusions, thoracenteses, pneumonias, or phrenic nerve dysfunctions was not significantly different between groups. Perioperative mortality was 1.9% in AVR and 1.0% in RT-AVR ( P = 0.417). Mechanical ventilation time after surgery was 9.7 ± 5.9 hours for AVR and 7.2 ±3.2 hours for RT-AVR patients ( P < 0.001). Stroke (odds ratio [OR] = 13.4, P = 0.008), increased postoperative blood loss (OR = 9.6, P <0.001), and chronic obstructive pulmonary disease (OR = 7.7, P < 0.001) were risk factors of prolonged mechanical lung ventilation. A week after surgery, the results of most pulmonary function tests were lower in the AVR than in the RT-AVR group ( P < 0.001 was seen for forced expiratory volume in the first second, vital capacity, total lung capacity, maximum inspiratory pressure and maximum expiratory pressure, P = 0.377 was seen for residual volume). Conclusions Right anterior aortic valve replacement minithoracotomy surgery with single-lung ventilation did not result in increased rate of respiratory system complications. Spirometry examinations revealed that pulmonary functional status was more impaired after AVR in comparison with RT-AVR surgery.

scholarly journals Minimally invasive aortic valve replacement with a catheter-based cerebral protection system: transferring percutaneous technologies into a surgical intervention

2019 ◽  
Vol 56 (5) ◽  
pp. 1016-1017
Author(s):  
Marco Di Eusanio ◽  
Mariano Cefarelli ◽  
Paolo Berretta ◽  
Filippo Capestro
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Low Risk ◽  
Cerebral Protection ◽  
Protection System ◽  
Surgical Aortic Valve Replacement ◽  
Minimally Invasive Surgical ◽  
Risk Patients

Abstract Patients with severe aortic valve stenosis are currently treated with 2 different interventional techniques: surgical aortic valve replacement or transcatheter aortic valve implantation (TAVI). Both have strengths and limitations. On the one hand, TAVI represents a valuable option in high- and intermediate-risk patients and is commonly preferred over surgical aortic valve replacement in subjects with porcelain or severely calcified aorta, on the other, the lack of data on valve durability raises concerns on its use in young, low-risk patients. We present herein the case of a low-risk 71-year-old patient with a severely calcified ascending aorta. We successfully combined our minimally invasive surgical approach with the use of a percutaneous cerebral protection system commonly employed during TAVI procedures. We believe that cardiac surgeons could adopt transcatheter technology to improve operative results.

Minimally Invasive versus Full Sternotomy for Isolated Aortic Valve Replacement in Low-risk Patients

2021 ◽  
Author(s):  
Mark J. Russo ◽  
Vinod H. Thourani ◽  
David J. Cohen ◽  
S. Chris Malaisrie ◽  
Wilson Y. Szeto ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Low Risk ◽  
Risk Patients

Minimally invasive aortic valve replacement: extracorporeal circulation optimization and minimally invasive extracorporeal circulation system evolution

Perfusion ◽  
2020 ◽  
Vol 35 (8) ◽  
pp. 865-869 ◽  
Author(s):  
Roberto Carozza ◽  
Diego Fazzi ◽  
Armando Pietrini ◽  
Mariano Cefarelli ◽  
Francesca Mazzocca ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Extracorporeal Circulation ◽  
Surgical Techniques ◽  
Air Embolism ◽  
Current Evidence ◽  
Circulation System ◽  
Transfusion Rate

Treatment of aortic valve disease has become less and less invasive during the last years, thanks to progress in anesthesiology, surgical techniques, and perfusion management. In fact, it has been demonstrated that shorter skin incision, combined with ultra-fast-track anesthesia and minimized extracorporeal circuit could improve clinical outcomes. Current evidence shows that minimally invasive extracorporeal circulation system is associated with reduced red blood cells’ transfusion rate, improved end-organ perfusion, decreased incidence of postoperative atrial fibrillation, air embolism leakage, and so less cerebral accidents with better neurological outcomes. Moreover, the use of a closed circuit seems to be more physiologic for the patients, reducing systemic inflammatory response due to less air–blood contact and the use of biocompatible surfaces. In the literature, the benefits of minimally invasive extracorporeal circulation are described mostly for coronary surgery but few data are nowadays available for minimally invasive extracorporeal circulation during aortic valve replacement. In this article, we describe our perfusion protocol in minimally invasive aortic valve replacement.

Current Surgical Risk Scores Overestimate Risk in Minimally Invasive Aortic Valve Replacement

2020 ◽  
pp. 155698452097177
Author(s):  
Ahmed Alnajar ◽  
Subhasis Chatterjee ◽  
Brendan P. Chou ◽  
Mariam Khabsa ◽  
Madeline Rippstein ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Scoring Systems ◽  
Roc Curves ◽  
Low Risk ◽  
Risk Scores ◽  
Risk Patients ◽  
Expected Mortality

Objective Risk-scoring systems for surgical aortic valve replacement (AVR) were largely derived from sternotomy cases. We evaluated the accuracy of current risk scores in predicting outcomes after minimally invasive AVR (mini-AVR). Because transcatheter AVR (TAVR) is being considered for use in low-risk patients with aortic stenosis, accurate mini-AVR risk assessment is necessary. Methods We reviewed 1,018 consecutive isolated mini-AVR cases (2009 to 2015). After excluding patients with Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) scores ≥4, we calculated each patient’s European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, TAVR Risk Score (TAVR-RS), and age, creatinine, and ejection fraction score (ACEF). We compared all 4 scores’ accuracy in predicting mini-AVR 30-day mortality by computing each score’s observed-to-expected mortality ratio (O:E). Area under the receiver operating characteristic (ROC) curves tested discrimination, and the Hosmer–Lemeshow goodness-of-fit tested calibration. Results Among 941 patients (mean age, 72 ± 12 years), 6 deaths occurred within 30 days (actual mortality rate, 0.6%). All 4 scoring systems overpredicted expected mortality after mini-AVR: ACEF (1.4%), EuroSCORE II (1.9%), STS-PROM (2.0%), and TAVR-RS (2.1%). STS-PROM best estimated risk for patients with STS-PROM scores 0 to <1 (0.6 O:E), ACEF for patients with STS-PROM scores 2 to <3 (0.6 O:E), and TAVR-RS for patients with STS-PROM scores 3 to <4 (0.7 O:E). ROC curves showed only fair discrimination and calibration across all risk scores. Conclusions In low-risk patients who underwent mini-AVR, current surgical scoring systems overpredicted mortality 2-to-3-fold. Alternative dedicated scoring systems for mini-AVR are needed for more accurate outcomes assessment.

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