Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany.
J Card Surg. 2021 Jan;36(1):97-104. doi: 10.1111/jocs.15177. Epub 2020 Nov 1.
Minimally invasive approaches to isolated aortic valve replacement (AVR) continue to gain popularity. This study compares outcomes of AVR through right anterolateral thoracotomy (RALT) to those of AVR through full median sternotomy (MS).
Outcomes of two propensity-matched groups of 85 each, out of 250 patients that underwent isolated AVR through RALT or MS at our two institutions, were compared in a retrospective study.
Propensity score matching resulted in 85 matched pairs with balanced preoperative characteristics. Procedure times were significantly shorter in the RALT group (median difference: 13 min [-25 to -0.5]; p = .039), cardiopulmonary bypass times were longer (median difference: 17 min [10-23.5]; p = < .001) and ventilation times shorter (median difference: 259 min [-390 to -122.5]; p = < .001). There was no significant difference in aortic cross-clamp times (median difference: 1.5 min [-3.5 to 6.5]; p = .573). The RALT group had lower rates of perioperative platelet transfusions (odds ratio [OR] = 0.00 [0.00-0.59]; p = .0078) and postoperative pneumonia (OR = 0.10 [0.00-0.70]; p = .012), as well as shorter hospitalization times (median difference: 2.5 days [-4.5 to -1]; p = .005). There were no significant differences regarding paravalvular leakage (p = .25), postoperative stroke (p = 1), postoperative atrial fibrillation (p = .12) or 1-year-mortality (p = 1).
This study found RALT to be an equally safe approach to surgical AVR as MS. Furthermore, RALT showed advantages regarding important aspects of postoperative recovery, especially concerning pulmonary function.
微创方法治疗孤立性主动脉瓣置换术（AVR）继续受到欢迎。本研究比较了右前外侧开胸（RALT）和全正中胸骨切开术（MS）行 AVR 的结果。
回顾性研究比较了在我们两家机构接受 RALT 或 MS 行孤立性 AVR 的 250 例患者中的两组 85 例患者的结果。这两组患者通过倾向评分匹配，在术前特征方面达到平衡。
倾向评分匹配产生了 85 对匹配对，具有平衡的术前特征。RALT 组的手术时间明显缩短（中位数差异：13 分钟[-25 至-0.5]；p=0.039），体外循环时间延长（中位数差异：17 分钟[10 至 23.5]；p<0.001），通气时间缩短（中位数差异：259 分钟[-390 至-122.5]；p<0.001）。主动脉阻断时间无显著差异（中位数差异：1.5 分钟[-3.5 至 6.5]；p=0.573）。RALT 组围手术期血小板输注率较低（比值比[OR]为 0.00[0.00 至 0.59]；p=0.0078）和术后肺炎（OR 为 0.10[0.00 至 0.70]；p=0.012），住院时间较短（中位数差异：2.5 天[-4.5 至-1]；p=0.005）。瓣周漏（p=0.25）、术后卒中（p=1）、术后心房颤动（p=0.12）或 1 年死亡率（p=1）无显著差异。
本研究发现 RALT 与 MS 一样是一种安全的外科 AVR 方法。此外，RALT 在术后恢复的重要方面显示出优势，特别是在肺功能方面。
