Minimally Invasive versus Conventional Aortic Valve Replacement: A Propensity-Matched Study from the UK National Data



Attia, Rizwan Q, Hickey, Graeme L ORCID: 0000-0002-4989-0054, Grant, Stuart W, Bridgewater, Ben, Roxburgh, James C, Kumar, Pankaj, Ridley, Paul, Bhabra, Moninder, Millner, Russell WJ, Athanasiou, Thanos
et al (show 4 more authors) (2016) Minimally Invasive versus Conventional Aortic Valve Replacement: A Propensity-Matched Study from the UK National Data. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 11 (1). 15 - 23.

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Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Minimally invasive aortic valve replacement (MIAVR) has been demonstrated as a safe and effective option but remains underused. We aimed to evaluate outcomes of isolated MIAVR compared with conventional aortic valve replacement (CAVR). </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Data from The National Institute for Cardiovascular Outcomes Research (NICOR) were analyzed at seven volunteer centers (2006–2012). Primary outcomes were in-hospital mortality and midterm survival. Secondary outcomes were postoperative length of stay as well as cumulative bypass and cross-clamp times. Propensity modeling with matched cohort analysis was used. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Of 307 consecutive MIAVR patients, 151 (49%) were performed during the last 2 years of study with a continued increase in numbers. The 307 MIAVR patients were matched on a 1:1 ratio. In the matched CAVR group, there was no statistically significant difference in in-hospital mortality [MIAVR, 4/307,(1.3%); 95% confidence interval (CI), 0.4%-3.4% vs CAVR, 6/307 (2.0%); 95% CI, 0.8%-4.3%; P = 0.752]. One-year survival rates in the MIAVR and CAVR groups were 94.4% and 94.6%, respectively. There was no statistically significant difference in midterm survival (P = 0.677; hazard ratio, 0.90; 95% CI, 0.56–1.46). Median postoperative length of stay was lower in the MIAVR patients by 1 day (P = 0.009). The mean cumulative bypass time (94.8 vs 91.3 minutes; P = 0.333) and cross-clamp time (74.6 vs 68.4 minutes; P = 0.006) were longer in the MIAVR group; however, this was significant only in the cross-clamp time comparison. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Minimally invasive aortic valve replacement is a safe alternative to CAVR with respect to operative and 1-year mortality and is associated with a shorter postoperative stay. Further studies are required in high-risk (logistic EuroSCORE &gt; 10) patients to define the role of MIAVR. </jats:p></jats:sec>

Item Type: Article
Depositing User: Symplectic Admin
Date Deposited: 07 Mar 2016 09:17
Last Modified: 02 Apr 2021 07:17
DOI: 10.1097/imi.0000000000000236
URI: https://livrepository.liverpool.ac.uk/id/eprint/2053619

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