Converging rapid deployment prostheses with minimal access surgery: analysis of early outcomes

Journal of Cardiothoracic Surgery

Thanos Athanasiou¹  M. Yousuf Salmasi²  Isabelle Roussin³  David Mozalbat⁴  Ishaan Chauhan⁴  Nikoleta Karadatkou⁴  George Asimakopoulos⁴  Alicja Zientara⁴  Cesare Quarto⁴  Kristo Papa⁴  Muhammad Ashraf⁴ 

[1] Department of Surgery, Imperial College London, 10th Floor QEQM, Praed Street, W2 1NY, London, UK;Department of Surgery, Imperial College London, 10th Floor QEQM, Praed Street, W2 1NY, London, UK;Royal Brompton and Harefield Foundation Trust, London, UK;East and North Hertfordshire NHS Trust, Stevenage, UK;Royal Brompton and Harefield Foundation Trust, London, UK;

关键词: Mini-sternotomy;    Surtureless;    Perceval;    Aortic valve replacement;   

DOI  :  10.1186/s13019-021-01739-w

来源: Springer

【 摘 要 】

BackgroundSutureless prostheses may have added benefit when combined with minimal access surgery, although this has not been fully assessed in the literature. This study aims to provide a comparative analysis of the Perceval valve comparing median sternotomy (MS) with mini-sternotomy (MIS).MethodsA retrospective analysis of prospectively collected data was conducted for all isolated aortic valve replacement (AVR), using the Perceval valve, for severe aortic stenosis cases in the period 2014 to 2019. Patients undergoing concomitant valve or revascularisation surgery were excluded.ResultsA total of 78 patients were included: MS group 41; MIS group 37. Operatively, bypass times were comparable between MS and MIS groups (mean 89.3 vs 83.4, p = 0.307), as were aortic cross clamp times (58.4 vs 55.9, p = 0.434). There were no operative deaths or new onset post-operative neurology. MIS was a predictor of reduced stay in the intensive care unit (coef − 3.25, 95% CI [− 4.93, − 0.59], p = 0.036) and hospital stay overall (p = 0.004). Blood transfusion units were comparable as were the incidence of heart block (n = 5 vs n = 3, p = 0.429) and new onset atrial fibrillation (n = 15 vs n = 9, p = 0.250). Follow-up echocardiography found a significant improvement in effective orifice area, left ventricular dimension and volume indices, and LVEF (p > 0.05) for all patients. Multivariate analysis found mini-sternotomy to be a predictor for reduced LV diastolic volume (coef − 0.35, 95% CI [− 1.02, − 0.05], p = 0.05).ConclusionsThe combination of minimal access surgery and sutureless AVR may enhance patient recovery and provide early LV remodelling.

【 授权许可】

CC BY