Use of Adjuncts Reduces Cardiopulmonary Bypass Time During Minimally Invasive Aortic Valve Replacement
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Alice Wang1,4, Sharon L. McCartney2, Judson B. Williams3, Asvin Ganapathi3, Donald D. Glower3, Alina Nicoara2, Jeffrey G. Gaca3 1Division of General Surgery, Duke University Medical Center, NC, USA |
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Background and aim of the study: Minimally invasive aortic valve replacement (MIAVR) through a mini-thoracotomy is comparable to AVR through a sternotomy, but may have increased surgical times. The development of adjuncts such as the automatic knot fastener and percutaneous coronary sinus (CS) catheter may reduce this disadvantage. Methods: A retrospective review conducted between 2002 and 2015 at a single institution revealed 78 patients who underwent MIAVR with adjuncts. The automatic knot fastener was used on all patients, and a successful CS catheter was placed and confirmed by echocardiography in 67 patients (86%). Patients were propensity matched against those who had MIAVR without adjuncts (n = 78) and through a median sternotomy (n = 78) for assessment of major morbidity. Variables were compared using an unpaired t-test, Wilcoxon rank sum test, chi-squared and Fisher’s exact test where appropriate. Results: Patients who underwent MIAVR with adjuncts |
had shorter cross-clamp times (70.5 versus 108.1 and 84.4 min; p <0.0001) and cardiopulmonary bypass (CPB) times (101.1 versus 166.12 and 127.7 min; p <0.0001) than those who underwent MIAVR without adjuncts or through a median sternotomy. Patients who underwent MIAVR received fewer blood transfusions compared to those undergoing AVR via a median sternotomy (0.6 and 1.2 versus 2.5; p <0.012). Patients who underwent MIAVR with adjuncts had similar rates of new-onset atrial fibrillation (AF) than those undergoing MIAVR without adjuncts (33% versus 22%; p = 0.11), but had higher rates of AF compared to the sternotomy group (33% versus 17%; p = 0.02). Rates of in-hospital morbidity and mortality were similar between all groups. Conclusion: The use of adjuncts during MIAVR led to a significant shortening of cross-clamp and CPB times, and to a requirement for fewer blood transfusions. Morbidity and mortality rates after MIAVR were similar to those in patients undergoing a median sternotomy. The Journal of Heart Valve Disease 2017;26:155-160 |
| Use of Adjuncts Reduces Cardiopulmonary Bypass Time During Minimally Invasive Aortic Valve Replacement | |
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