Minimally Invasive Versus Full Sternotomy for Isolated Aortic Valve Replacement in Low-Risk Patients

• Published in: The Annals of thoracic surgery Vol. 114; no. 6; pp. 2124 - 2130
• Main Authors: Russo, Mark J., Thourani, Vinod H., Cohen, David J., Malaisrie, S. Chris, Szeto, Wilson Y., George, Isaac, Kodali, Susheel K., Makkar, Raj, Lu, Michael, Williams, Mathew, Nguyen, Tom, Aldea, Gabriel, Genereux, Philippe, Fang, H. Kenith, Alu, Maria C., Rogers, Erin, Okoh, Alexis, Herrmann, Howard C., Kapadia, Samir, Webb, John G., Smith, Craig R., Leon, Martin B., Mack, Michael J.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.12.2022
• Subjects: Aortic Valve - surgery; Aortic Valve Stenosis - complications; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis Implantation - adverse effects; Humans; Postoperative Complications - etiology; Quality of Life; Sternotomy - adverse effects; Stroke - complications; Stroke - etiology; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; PARTNER; ED-5D-5L VAS; RAT; HS; SAVR; FS; TAVR; SF-36; CT; LOS; KCCQ-OS; ICU; CABG; MI; AVR
• ISSN: 0003-4975; 1552-6259; 1552-6259
• DOI: 10.1016/j.athoracsur.2021.11.048

Surgical aortic valve replacement can be performed through a minimally invasive (MI) or full sternotomy (FS) approach. The present study compared outcomes of MI vs FS for isolated surgery among patients enrolled in the Placement of Aortic Transcatheter Valves (PARTNER) 3 low-risk trial. Patients with severe, symptomatic aortic stenosis at low surgical risk with anatomy suitable for transfemoral access were eligible for PARTNER 3 enrollment. The primary outcome was the composite end point of death, stroke, or rehospitalization (valve-, procedure-, or heart failure-related) at 1 year. Secondary outcomes included the individual components of the primary end point as well as patient-reported health status at 30 days and 1 year. In the PARTNER 3 study, 358 patients underwent isolated valve replacement at 68 centers through an MI (n = 107) or FS (n = 251) approach (8 patients were converted from MI to FS). Mean age and Society of Thoracic Surgeons score were similar between groups. The Kaplan-Meier estimate of the primary outcome was similar in the MI vs FS groups (16.9% vs 14.9%; hazard ratio, 1.15; 95% CI, 0.66-2.03; P = .618). There were no significant differences in the 1-year rates of all-cause death (2.8% vs 2.8%), all stroke (1.9% vs 3.6%), or rehospitalization (13.3% vs 10.6%, P > .05 for all). Quality of life, as assessed by the Kansas City Cardiomyopathy Questionnaire score at 30 days or 1 year, was comparable in both groups. For patients at low risk for isolated surgery, MI and FS approaches were associated with similar in-hospital and 1-year outcomes.