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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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%
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PowerPoint Slide Presentation on Aortic valve replacement (AVR) is the golden standard of treatment
PowerPoint Slide Presentation on 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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