Document Detail


Propensity score-matched analysis of aortic valve replacement by mini-thoracotomy.
MedLine Citation:
PMID:  21053740     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIM OF THE STUDY: Although minimally invasive aortic valve replacement (MIAVR) through an anterolateral mini-thoracotomy has been shown to reduce surgical trauma, the technique is utilized only at a few selected heart surgery centers. The study aim was to demonstrate the implementation of a MIAVR program at the Innsbruck Medical University, Austria.
METHODS: Between October 2006 and January 2009, a total of 315 patients underwent elective isolated aortic valve replacement (AVR). Of these patients, 87 (27.6%) received MIAVR, while the remainder (n = 228) underwent 'conventional' AVR by full sternotomy. In the MIAVR group, 76 patients (87%) were cannulated via the femoral artery. The mean EuroSCORE was 5.7 +/- 2.2 in the MIAVR group, and 6.7 +/- 2.9 in the AVR group (p < 0.001). Propensity score matching was used to reduce the impact of treatment selection in the comparison of MIAVR with conventional AVR. The propensity score was used to yield two matched groups by means of a 1:1 sample matching.
RESULTS: The total operative, cardiopulmonary bypass and aortic cross-clamp times were significantly longer in the MIAVR group compared to the matched AVR group. The actuarial one-year survival was 96% in the MIAVR group, and 98% in the propensity-matched AVR group (p = 0.57). Reoperation due to bleeding was necessary in 4.6% of the MIAVR group (four patients, three by mini-thoracotomy) compared to 5.7% in the matched AVR group (n = 5; p = 0.38). A total of six MIAVR patients (6.9%) had complications from the cannulated groin, predominantly lymphatic fistula formation. Additionally, there was a trend towards a higher rate of renal insufficiency in the MIAVR group (p = 0.07).
CONCLUSION: MIAVR can be safely implemented as routine cardiac surgery procedure, although the operative times are significantly longer. The early postoperative outcome was equal to that of the sternotomy approach, but postoperative complications were predominantly associated with femoral cannulation.
Authors:
Elfriede Ruttmann; Thomas S Gilhofer; Hanno Ulmer; Orest Chevtchik; Alfred Kocher; Roland Schistek; Guenther Laufert; Ludwig C Mueller
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  19     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-11-08     Completed Date:  2010-12-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  606-14     Citation Subset:  IM    
Affiliation:
Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. elfriede.ruttmann@i-med.ac.at
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Valve / surgery*
Cardiovascular Surgical Procedures / methods
Female
Follow-Up Studies
Heart Valve Diseases / surgery*
Heart Valve Prosthesis Implantation / methods*
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Propensity Score*
Retrospective Studies
Sternotomy / methods
Surgical Procedures, Minimally Invasive / methods*
Thoracotomy / methods*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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