Background: Aim of this multicenter retrospective study was to compare early and mid- term clinical and hemodynamic results of aortic valve replacement (AVR) with rapid-deployment bioprostheses (RDB) performed through conventional full-sternotomy versus mini-sternotomy. Methods: Data from the Italian multicenter registry of AVR with RDB (INTU-ITA registry) were analyzed. Patients were divided into two groups: full sternotomy (FS) and mini-sternotomy (MS). Primary endpoint was the comparison of early and mid-term mortality. Secondary endpoints were: comparison of intra-operative variables, complications and hemodynamic performance. A propensity score weighting approach was employed for data analysis. Results: A total of 1057 patients were analyzed: 435 (41.2%) and 622 (58.8%) in Group FS and MS, respectively. Thirty-day mortality was 1.6% and 0.6% in FS and MS groups, respectively (p=0.074). CPB time was 78.5 minutes and 83 minutes in FS and MS group, respectively (p=0.414). In the overall cohort, the incidence of intraoperative complications and of device success was 3.8% (40 patients) and 95.9% (1014 patients), respectively with no significant differences between groups. Survival at 1, 3, 5 years was 94.1% and 98.1%, 88.5% and 91.8%, 85.2% and 84.8% in FS and MS groups, respectively (p=0.412). The two groups showed similar postoperative gradients (Median mean gradient, FS: 10.0 mmHg, MS: 11.0 mmHg; p=0.170) and also similar incidence of patient-prosthesis mismatch (FS: 7%, MS: 6.4%,p=0.647). Conclusions: According to our data, RDB allow to perform minimally-invasive AVR with similar surgical times and similar clinical and hemodynamic outcomes than conventional surgery and should be considered the first choice in these procedures.

Minimally Invasive Vs. Conventional Aortic Valve Replacement With Rapid-Deployment Bioprostheses / A. D'Onofrio, C. Tessari, G. Lorenzoni, G. Cibin, G.L. Martinelli, F. Alamanni, G. Polvani, M. Solinas, M. Massetti, M. Merlo, I. Vendramin, M. Di Eusanio, C. Mignosa, D. Mangino, C. Russo, M. Rinaldi, D. Pacini, L. Salvador, C. Antona, D. Maselli, R. De Paulis, G. Luzi, O. Alfieri, C.M. De Filippo, M. Portoghese, F. Musumeci, A. Colli, D. Gregori, G. Gerosa. - In: ANNALS OF THORACIC SURGERY. - ISSN 0003-4975. - (2020). [Epub ahead of print] [10.1016/j.athoracsur.2020.06.150]

Minimally Invasive Vs. Conventional Aortic Valve Replacement With Rapid-Deployment Bioprostheses

F. Alamanni;G. Polvani;C. Antona;
2020

Abstract

Background: Aim of this multicenter retrospective study was to compare early and mid- term clinical and hemodynamic results of aortic valve replacement (AVR) with rapid-deployment bioprostheses (RDB) performed through conventional full-sternotomy versus mini-sternotomy. Methods: Data from the Italian multicenter registry of AVR with RDB (INTU-ITA registry) were analyzed. Patients were divided into two groups: full sternotomy (FS) and mini-sternotomy (MS). Primary endpoint was the comparison of early and mid-term mortality. Secondary endpoints were: comparison of intra-operative variables, complications and hemodynamic performance. A propensity score weighting approach was employed for data analysis. Results: A total of 1057 patients were analyzed: 435 (41.2%) and 622 (58.8%) in Group FS and MS, respectively. Thirty-day mortality was 1.6% and 0.6% in FS and MS groups, respectively (p=0.074). CPB time was 78.5 minutes and 83 minutes in FS and MS group, respectively (p=0.414). In the overall cohort, the incidence of intraoperative complications and of device success was 3.8% (40 patients) and 95.9% (1014 patients), respectively with no significant differences between groups. Survival at 1, 3, 5 years was 94.1% and 98.1%, 88.5% and 91.8%, 85.2% and 84.8% in FS and MS groups, respectively (p=0.412). The two groups showed similar postoperative gradients (Median mean gradient, FS: 10.0 mmHg, MS: 11.0 mmHg; p=0.170) and also similar incidence of patient-prosthesis mismatch (FS: 7%, MS: 6.4%,p=0.647). Conclusions: According to our data, RDB allow to perform minimally-invasive AVR with similar surgical times and similar clinical and hemodynamic outcomes than conventional surgery and should be considered the first choice in these procedures.
Settore MED/23 - Chirurgia Cardiaca
2020
8-ott-2020
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/782709
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