Minimal Invasive Aortic Valve Surgery is Associated with Decreased Morbidity and Resource Utilization

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Introduction Aortic valve replacement (AVR) is the golden standard of treatment for severe aortic stenosis and regurgitation for the last 35 years. However, a significant change in the approach to AVR has recently occured as several investigators have described minimal invasive techniques.

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Introduction Minimal invasive cardiac surgical techniques (MIC) have recently been developed for aortic valve replacement (AVR) MIC-AVR advantages: decreased tissue damage decreased bleeding faster postoperative ambulation MIC-AVR disadvantages: more technically demanding longer operating times difficult de-airing

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Introduction Several studies in the literature comparing MIC to conventional (c-) AVR: significantly better outcomes little or no benefit significantly worse outcomes Does these outcomes have a relation to experience with minimal invasive techniques? Approximately 1000 minimal invasive valve (MV and AV) procedures at our institution since 1997

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Purpose To compare outcomes in patients undergoing MIC- versus c-AVR in our institution over a one-year period Methods Review of prospective data All patients undergoing MIC- (n =176) or c-AVR (n =258) +/- Asc. Ao. replacement Excluded patients with significant CAD, reoperations, cardiogenic shock or renal failure

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Methods Inspect CXR to localize skin incision (5 - 8 cm) Upper sternotomy with "J" (or inverted "T") extension into right 3rd or 4th ICS Conversion to full sternotomy was required in 8 MIC pts (2%)

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Methods CPB circuit: straight, wire reinforced arterial cannula oval, flattened venous cannula in RA appendage (exit through subxiphoid incision) vacuum suction (-30 to -50 mm Hg) standard cardioplegia and surgical management for AV +/- ascending aorta avoiding air emboli: flood operative field with CO2 prolonged venting aortic root

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Methods

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Methods

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Results: Preop Variables

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Results: Intraop Variables

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Results: Blood Loss / Utilization RBC’s (units) FFP (units) * p < 0.05 * * Blood Loss (litres) *

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Results: CKMB Levels POD #2 POD #3 POD #1 CKMB (U/I)

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Results: Resource Utilization ICU Stay Hospital Stay * p < 0.05 * * Ventilation Time Length of Time (Days)

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Results: Other Outcomes

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Conclusions MIC-AVR associated with: cosmetically acceptable result less tissue damage less bleeding / blood transfusions No evidence of air emboli with MIC-AVR: post-crossclamp VF ? lower in MIC-AVR CKMB release ? same as c-AVR delirium / stroke ? same as c-AVR

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Conclusions MIC-AVR associated with: ? lower incidents of respiratory failure shorter ICU and hospital stays MIC-AVR may be the method of choice for AV and ascending aortic replacement

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1999 STS Mortality for AVR (n = 9,095) Elective Emergent Overall Urgent Operative Mortality (%) 3.6% 2.6% 5.6% 4.4% 12.8% 7.8% 33.3%

Aortic Dissection

ADVERSE CEREBRAL OUT...

Mitral Valve Prolaps...

Aortic Regurgitation

Aortic Stenosis

Echo in the Evaluati...

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	dolln@medizin.uni-leipzig.de 5 Years ago.



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