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Thorac Cardiovasc Surg 2020; 68(02): 141-147
DOI: 10.1055/s-0038-1668497
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Minimally Invasive Redo-Aortic Valve Replacement: Reduced Operative Times as Compared to Full Sternotomy

Cenk Oezpeker
1   Cardiac Surgery, Landeskrankenhaus Innsbruck Universitatskliniken, Innsbruck, Austria
,
Fabian Barbieri
1   Cardiac Surgery, Landeskrankenhaus Innsbruck Universitatskliniken, Innsbruck, Austria
,
Vitalijs Zujs
1   Cardiac Surgery, Landeskrankenhaus Innsbruck Universitatskliniken, Innsbruck, Austria
,
Michael Grimm
2   Landeskrankenhaus Innsbruck Universitatskliniken, Innsbruck, Austria
,
Antonio Lio
3   Department of Adult Cardiac Surgery, Tor Vergata University, Rome, Italy
,
Mattia Glauber
4   Instituto Clinico Sant Ambrogio, Milano, Italy
,
Nikolaos Bonaros
1   Cardiac Surgery, Landeskrankenhaus Innsbruck Universitatskliniken, Innsbruck, Austria
› Author Affiliations Sources of Funding None
Further Information

Publication History

09 April 2018

05 July 2018

Publication Date:
16 August 2018 (online)

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Abstract

Objectives Increasing experience with minimally invasive cardiac (MIC) aortic valve (AV) replacement makes AV reoperations (rAVR) an appealing alternative to conventional redo surgery. The aim of the study was to compare the perioperative outcome after isolated MIC versus full-sternotomy (FS) rAVR.

Methods We retrospectively analyzed data of 116 patients from three centers who underwent rAVR by using a FS (n = 70, 60.3%) or a partial upper sternotomy approach (n = 46, 39.7%). Both groups were compared in terms of 30-day mortality by using binary-logistic regression models. Further the EuroSCORE II was used to adjust for preoperative conditions in a multivariable model. Perioperative times and complications were compared between the two groups.

Results There was no statistically significant difference in perioperative mortality between FS (n = 5, 7.1%) and MIC (n = 1, 2.2%) rAVR in the original population (odds ratio [OR] 3.462, 95% confidence interval [CI] 0.391–30,635, p = 0.264) and after adjusting for EuroSCORE II (OR 2.759, 95% CI 0.298–25.567, p = 0.372). Cardiopulmonary bypass- (115.5 minutes vs. 137.5 minutes, p = 0.070) and cross-clamp times (69.0 minutes vs. 81.0 minutes, p = 0.028) were reduced in the MIC group. There was a lower prevalence of postoperative renal failure requiring renal replacement therapy (RRT) in the MIC group 0 and 8.6% (p = 0.041), respectively. No differences were detected between the groups regarding postoperative complications.

Conclusion MIC rAVR is associated with reduced cardiopulmonary and cross-clamp times as well as the need for RRT as compared with FS. MIC-rAVR seems to be a viable option in surgical candidates for AV reoperations.

Keywords

redo aortic valve replacement - partial upper sternotomy - minimally invasive cardiac surgery
 

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