MINISTERNOTOMY AORTIC VALVE REPLACEMENT PROVIDES EQUIVALENT SHORT- AND LONG-TERM SURVIVAL RATES IN BC PATIENTS IN COMPARISON WITH THE STANDARD APPROACH
CCC ePoster Library. Adreak N. 10/26/19; 280543; 308
Dr. Najah Adreak
Dr. Najah Adreak
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Abstract
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BACKGROUND: Advantages of mini-sternotomy aortic valve replacement (MSAVR) include improved cosmetic, reduction in postoperative pain, blood loss, length of stay (LOS) and better wound healing. However, MSAVR is not widely adopted by surgeons and the clinical outcomes of MSAVR have not been reported in Canada. We study the outcomes of MSAVR in our institution in British Columbia comparing to the full sternotomy aortic valve replacement (FSAVR).

METHODS AND RESULTS: We performed a retrospective analysis of the Cardiac Service BC database to evaluate all isolated aortic valve replacement (AVR) performed in our institution from January 2007 to December 2016. Nine hundred and ten patients were identified (776 conventional AVR and 134 MSAVR) with a median follow-up period of 6.2 yrs (95% CL: 3.8 to 8.5). Standard statistical analysis was conducted. Baseline variables between the two surgery groups are similar with a mean age of 70.7 ± 11.8 yrs in MSAVR vs 69.7 ± 12.2 in the standard group (p=0.38), and 40% were females. Those who had MSAVR group had higher NYHA III/IV 76.8% vs 49.3% (p=0.001) and had a greater incidence of renal failure (12.7% vs 8.8%, p=0.15). Bioprosthetic valves were implanted in 93.3% (MSAVR) and 93.8% (FSAVR). The mean cardiopulmonary bypass (CPB) and aortic cross-clamp (XC) times were shorter in MSAVR group with 74 vs 80min (p=0.014) and 56 vs 62min (p=0.08), respectively. There were no significant differences in the incidence of atrial fibrillation and renal dysfunction. There was no significant difference in 30-day mortality (p=0.79) and long-term mortality between groups (p=0.70). LOS was shorter in the MSAVR group (mean 7.8 ± 6.3 vs 8.6 ± 7.2 days, p=0.006).

CONCLUSION: MSAVR can be performed safely with similar short- and long-term survival rates. Shorter CPB and XC times and LOS were shorter in MSAVR. MSAVR should be performed when feasible.
BACKGROUND: Advantages of mini-sternotomy aortic valve replacement (MSAVR) include improved cosmetic, reduction in postoperative pain, blood loss, length of stay (LOS) and better wound healing. However, MSAVR is not widely adopted by surgeons and the clinical outcomes of MSAVR have not been reported in Canada. We study the outcomes of MSAVR in our institution in British Columbia comparing to the full sternotomy aortic valve replacement (FSAVR).

METHODS AND RESULTS: We performed a retrospective analysis of the Cardiac Service BC database to evaluate all isolated aortic valve replacement (AVR) performed in our institution from January 2007 to December 2016. Nine hundred and ten patients were identified (776 conventional AVR and 134 MSAVR) with a median follow-up period of 6.2 yrs (95% CL: 3.8 to 8.5). Standard statistical analysis was conducted. Baseline variables between the two surgery groups are similar with a mean age of 70.7 ± 11.8 yrs in MSAVR vs 69.7 ± 12.2 in the standard group (p=0.38), and 40% were females. Those who had MSAVR group had higher NYHA III/IV 76.8% vs 49.3% (p=0.001) and had a greater incidence of renal failure (12.7% vs 8.8%, p=0.15). Bioprosthetic valves were implanted in 93.3% (MSAVR) and 93.8% (FSAVR). The mean cardiopulmonary bypass (CPB) and aortic cross-clamp (XC) times were shorter in MSAVR group with 74 vs 80min (p=0.014) and 56 vs 62min (p=0.08), respectively. There were no significant differences in the incidence of atrial fibrillation and renal dysfunction. There was no significant difference in 30-day mortality (p=0.79) and long-term mortality between groups (p=0.70). LOS was shorter in the MSAVR group (mean 7.8 ± 6.3 vs 8.6 ± 7.2 days, p=0.006).

CONCLUSION: MSAVR can be performed safely with similar short- and long-term survival rates. Shorter CPB and XC times and LOS were shorter in MSAVR. MSAVR should be performed when feasible.
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