015PROPENSITY SCORE ANALYSIS OF OUTCOMES FOLLOWING MINIMALLY INVASIVE VERSUS CONVENTIONAL AORTIC VALVE REPLACEMENT

• Published in: Interactive cardiovascular and thoracic surgery Vol. 19; no. suppl_1; pp. S5 - S6
• Main Authors: Shehada, S., Voss, B., Elhmidi, Y., Öztürk, O., Guenzinger, R., Wottke, M., Lange, R., Mazzitelli, D.
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.10.2014
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivu276.15

Objectives: Minimally invasive aortic valve replacement (MIAVR, upper partial sternotomy) is performed in many institutions. Besides the improved cosmetic results, we investigated if these procedures have any advantages over conventional aortic valve replacement (CAVR, full sternotomy). Methods: We retrospectively analysed data of 2103 patients who underwent primary, isolated aortic valve replacement in our department between January 2001 and May 2012 (MIAVR, n = 936; CAVR, n = 1167). After propensity score matching for relevant preoperative risk factors (age, sex and comorbidities), 585 matched patients were included in each subgroup. Follow-up was 98% completed. Results: Mean age (65 ± 10.5 vs 65.7 ± 11.5 years, P = 0.23), gender (females 37.2%, P = 0.9), aortic cross-clamp times (65.6 ± 18.4 vs 64.3 ± 19.8 min, P = 0.25), and postoperative blood loss [median (range) 400 (224–683) vs 400 (250–610) ml/24 h, P = 0.83] were similar in both subgroups. Thirty-day and 1-year mortality were also not significantly different (1.5% vs 1.7%, P = 0.74 and 3.1% vs 4.8%, P = 0.12, respectively). In contrast, cardiopulmonary bypass (CPB) times were significantly longer in MIAVR (93.5 ± 25 vs 88 ± 28 min, P < 0.001). Intraoperative and postoperative autologous blood transfusions were significantly lower in MIAVR (927.2 ± 425.6 and 170.2 ± 47.6 ml vs 1036.4 ± 599.6 and 243.5 ± 89.3 ml, P < 0.001, respectively). Intubation times were significantly shorter in MIAVR [median (range) 7 (5–11) vs 8 (6–14) h, P = 0.01]. The incidence of renal and respiratory insufficiency (need for non-invasive ventilation, re-intubation) was significantly lower in MIAVR (9 vs 11.8%, P < 0.001 and 8.5 vs 16%, P = 0.03, respectively). Conclusion: MIAVR is a safe procedure which yields excellent cosmetic results. Although CPB times are slightly longer, MIAVR is associated with less blood transfusions, shorter ventilation time and lower rates of renal and respiratory insufficiency.