Low-Risk Surgical Aortic Valve Replacement in the Era of Transcatheter Aortic Valve Implantation

Open surgical aortic valve replacement (SAVR) is a viable alternative to transcatheter implantation in low-risk patients. In this light, we evaluated the safety and effectiveness of SAVR performed through conventional and less invasive surgical approaches in a high-volume center. We retrospectively...

Full description

Saved in:

Bibliographic Details
Published in:	Texas Heart Institute journal Vol. 49; no. 1
Main Authors:	Jovanovic, Milos M, Micovic, Slobodan V, Peric, Miodrag S, Zivkovic, Igor S, Krasic, Stasa D, Milicevic, Ognjen S, Stankovic, Stefan P, Vukovic, Petar M
Format:	Journal Article
Language:	English
Published:	United States Texas Heart® Institute, Houston 01-01-2022
Subjects:	Aortic Valve - surgery Aortic Valve Stenosis - diagnosis Aortic Valve Stenosis - etiology Aortic Valve Stenosis - surgery Clinical Investigation Heart Valve Prosthesis Implantation - adverse effects Heart Valve Prosthesis Implantation - methods Humans Retrospective Studies Risk Factors Sternotomy - adverse effects Sternotomy - methods Stroke - epidemiology Stroke - etiology Surgical Wound Infection - epidemiology Surgical Wound Infection - etiology Surgical Wound Infection - surgery Transcatheter Aortic Valve Replacement - adverse effects Treatment Outcome sternotomy transcatheter aortic valve replacement minimally invasive surgical procedures thoracotomy Aortic valve stenosis/surgery heart valve prosthesis implantation sutureless surgical procedures treatment outcome
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Open surgical aortic valve replacement (SAVR) is a viable alternative to transcatheter implantation in low-risk patients. In this light, we evaluated the safety and effectiveness of SAVR performed through conventional and less invasive surgical approaches in a high-volume center. We retrospectively reviewed the records of 395 consecutive patients who underwent open SAVR from January 2019 through December 2019 in our center. We evaluated and compared the operative results and postoperative major adverse outcomes of 3 surgical approaches: full median sternotomy (n=267), upper ministernotomy (ministernotomy) (n=106), and right anterior thoracotomy (minithoracotomy) (n=22). Overall, the 30-day all-cause mortality rate was 0.8% (3 patients). Stroke occurred in 8 patients (2%), disabling stroke in 4 patients (1%), myocardial infarction in 1 (0.2%), and surgical site infection in 13 (3.2%). There was no difference in 30-day mortality rate or incidence of postoperative major adverse events among the 3 surgical groups. Stroke and surgical site infection occurred more frequently, but not significantly so, in the full-sternotomy group. The mean hospital stay was longer after full sternotomy (9.1 ± 5.5 d) than after ministernotomy (7.5 ± 2.9 d) or minithoracotomy (7.4 ± 1.9 d) (P=0.012). Our findings suggest that open SAVR performed in a high-volume center is associated with a low early mortality rate and that less invasive approaches result in faster postoperative recovery and shorter hospital stays.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0730-2347 1526-6702
DOI:	10.14503/THIJ-20-7435