Open Collections

Ministernotomy aortic valve replacement decreases the need for blood transfusion and improves clinical outcomes in comparison to conventional full sternotomy approach

University of British Columbia

Background: Advantages of mini-sternotomy aortic valve replacement (MSAVR) including improved cosmesis, reduction in postoperative pain, blood loss, shorter length of hospital stay (LOS) and better wound healing. However, MSAVR is not widely adopted by surgeons and clinical outcomes of MSAVR have not been reported in Canada. We study the outcomes of MSAVR in our institution in British Columbia (BC) comparing to full sternotomy aortic valve replacement (FSAVR). Methods: Retrospective analysis of Cardiac Service BC database to evaluate all isolated aortic valve replacement (AVR) performed in our institution from Jan 2007 to Dec 2016. Nine hundred and ten patients were identified (776 FSAVR and 134 MSAVR) with a median follow-up period of 6.2 years. Standard statistical analysis was conducted. Results: Baseline variables between the two groups were similar with a mean age of 70 years and 40% were females. 77.5% of MSAVR patients were in NYHA III/IV vs 49.3% (p=<0.001) and had a greater incidence of renal failure (12.7% vs 8.8%, p=0.15). Bioprosthetic valve implanted in more than 90 % of cases. The freedom from blood product transfusion in the MSAVR group was significantly higher than FSAVR (65.7% vs 49.6 % respectively, p= <0.001). The CBP and AXT times were approximately 9 and 6 minutes shorter in the MSAVR group than FSAVR, respectively (mean CBP 75.4 ± 14.7 vs 84.3 ± 30.0, p=0.014, and mean AXT 58.5 ± 12.2 vs 64.7 ± 24.7, p=0.08, respectively). There were no significant differences in the incidence of new onset of atrial arrythmias and renal dysfunction. There was no significant difference in 30-day (p=0.79) and long-term mortality between groups (p=0.70). LOS in the hospital was shorter in the MSAVR group (mean 7.8 ± 6.2 vs 8.6 ± 7.2, p=0.006). Conclusion: We have validated that mini sternotomy is an effective alternative to the standard approach for aortic valve replacement. It is proven to be a safe and effective treatment for aortic stenosis with a decrease in blood product transfusion rate, and hospital stays with equivalent 30-day mortality and long-term survival rate. It should be considered as part of the armamentarium of cardiac surgeons in the modern era.

Text

2021-01-13

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/77073

Surgery

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/