Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Surgery. 2018 Aug;164(2):282-287. doi: 10.1016/j.surg.2018.02.018. Epub 2018 Apr 24.
Minimally invasive aortic valve replacement using upper-hemisternotomy has been associated with improved results compared to full sternotomy aortic valve replacement. Given the likely expansion of transcatheter aortic valve replacement to low-risk patients, we examine contemporary outcomes after full sternotomy and minimally invasive aortic valve replacement in low-risk patients using our 15-year experience.
Two thousand ninety-five low-risk patients (Society of Thoracic Surgeons Predicted Risk of Mortality score <4) underwent elective isolated aortic valve replacement, including 1,029 (49%) minimally invasive and 1,066 (51%) full sternotomy, from 2002 to 2015.
Compared to minimally invasive aortic valve replacement patients, full sternotomy aortic valve replacement patients had a greater burden of comorbidities, including diabetes, stroke, congestive heart failure, and predicted risk of mortality (all P ≤ .05). Operative mortality, stroke, and reoperation rates for bleeding were similar. There was a clinical trend toward shorter median intensive care unit stay and significantly shorter hospital length of stay among minimally invasive aortic valve replacement patients. Adjusted survival analysis identified age, chronic kidney disease, prior sternotomy, and congestive heart failure as predictors of decreased survival (all P ≤ .05), while type of intervention approach was nonsignificantly different.
In low-risk patients, minimally invasive aortic valve replacement results in similar mortality, stroke, reoperation rates for bleeding, and midterm survival (after adjusting for confounders), but shorter hospital length of stay and a trend (P = .075) toward shorter intensive care unit stay, compared to full sternotomy aortic valve replacement. Therefore, minimally invasive aortic valve replacement should stand as a benchmark against transcatheter aortic valve replacement in these patients.
与全胸骨切开术主动脉瓣置换术相比，经胸骨上半部分切开的微创主动脉瓣置换术与改善的结果相关。鉴于经导管主动脉瓣置换术可能扩展到低危患者，我们使用我们 15 年的经验检查了低危患者全胸骨切开术和微创主动脉瓣置换术的当代结果。
2095 例低危患者（胸外科医师协会预测死亡率评分<4）接受了选择性单纯主动脉瓣置换术，包括 1029 例（49%）微创和 1066 例（51%）全胸骨切开术，从 2002 年到 2015 年。
与微创主动脉瓣置换术患者相比，全胸骨切开术主动脉瓣置换术患者的合并症负担更大，包括糖尿病、中风、充血性心力衰竭和预测死亡率（所有 P≤0.05）。手术死亡率、中风和出血再手术率相似。微创主动脉瓣置换术患者的重症监护病房中位停留时间和住院时间明显缩短，存在临床趋势。调整后的生存分析确定年龄、慢性肾脏病、先前的胸骨切开术和充血性心力衰竭是降低生存率的预测因素（所有 P≤0.05），而干预方法类型则无显著差异。
在低危患者中，微创主动脉瓣置换术在死亡率、中风、出血再手术率和中期生存率（在调整混杂因素后）方面与全胸骨切开术主动脉瓣置换术相似，但住院时间较短，重症监护病房停留时间有缩短的趋势（P=0.075），与全胸骨切开术主动脉瓣置换术相比。因此，微创主动脉瓣置换术应该成为这些患者经导管主动脉瓣置换术的基准。
