Minimally Invasive Aortic Valve Replacement: Is It Safe in Surgical Training?

Objectives: Isolated aortic valve replacement (AVR) plays a central role in surgical training. In line with a general trend toward minimally-invasive surgery (MIS), nowadays MIS AVR is considered the standard of care in many centers, though it is technically more demanding. This study aims to investigate if MIS AVR is safe during surgical training or if it should be reserved for experienced surgeons.

Methods: We retrospectively analyzed 718 patients, who underwent isolated AVR between 2010 and 2017 at our institution, 597 via full sternotomy (169 by residents, 428 by attendings) and 121 via MIS (partial upper sternotomy, 21 by residents, 100 by attendings). Intraoperative details (cardiopulmonary bypass [CPB] and cross-clamp time) as well as short-term outcomes (30-day-mortality, stay on ICU, re-sternotomy due to bleeding and neurological complications) were evaluated and compared in four groups: MIS AVR residents versus attendings, full sternotomy residents versus attendings, residents MIS AVR versus full sternotomy and attendings MIS AVR versus full sternotomy.

Results: Considering intraoperative details, residents had significantly longer CPB and cross-clamp times compared with attendings in MIS as well as full sternotomy AVR. However, when comparing intraoperative details for residents in MIS versus full sternotomy AVR, no significant difference in CPB and cross-clamp time was found. Considering all parameters of short-term outcome, there was no significant difference between residents and attendings in MIS as well as full sternotomy AVR. Furthermore, there was no significant difference in all short-term parameters between MIS and full sternotomy AVR in the residents group.

Conclusion: In this study, surgical education with MIS AVR is feasible and does not compromise patients´ safety. Residents did not perform inferior when performing MIS AVR compared with full sternotomy AVR.