Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Witten, Germany.
Department of Cardiac Surgery, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
Adv Ther. 2022 Sep;39(9):4266-4284. doi: 10.1007/s12325-022-02263-6. Epub 2022 Jul 29.
Propensity score analysis of midterm outcomes after isolated aortic valve replacement through right anterior mini-thoracotomy and partial upper sternotomy could provide information about the most beneficial minimally invasive technique for the patient based on the preoperative risk factors.
Between March 2015 and February 2021, 694 minimally invasive isolated aortic valve surgeries were performed at our institution. Among these, 441 right anterior mini-thoracotomies and 253 partial upper sternotomies were performed. A propensity score analysis was performed in 202 matched pairs.
Cardiopulmonary bypass time and cross-clamp time were significantly shorter in the right anterior mini-thoracotomy group than in the partial upper sternotomy group (p = 0.001 and p < 0.001, respectively). Time to first mobilization and hospital stay were significantly shorter in the right anterior mini-thoracotomy group than in the partial upper sternotomy group (p = 0.005, p = 0.001, respectively). A significantly lower incidence of revision surgery was noted in the right anterior mini-thoracotomy group than in the partial upper sternotomy group (p = 0.046). No significant differences in 30-day mortality (p = 1.000) and 1-year mortality (p = 0.543) were noted. Kaplan-Meier survival estimates were 96.3% in the right anterior mini-thoracotomy group and 92.7% in the partial upper sternotomy group after 4 years (log rank 0.169), respectively.
Despite the technical challenges, right anterior mini-thoracotomy can be chosen as first-line strategy for isolated aortic valve replacement. For patients unsuitable for this technique, the partial upper sternotomy remains a safe method that can be performed by a wide range of surgeons.
通过右前小开胸和部分上胸骨切开术对孤立性主动脉瓣置换术的中期结果进行倾向评分分析，可以根据术前危险因素为患者提供最有益的微创技术信息。
2015 年 3 月至 2021 年 2 月，我院共进行了 694 例微创孤立性主动脉瓣手术。其中，441 例为右前小开胸，253 例为部分上胸骨切开术。对 202 对匹配的患者进行了倾向评分分析。
右前小开胸组体外循环时间和主动脉阻断时间明显短于部分上胸骨切开组（p=0.001 和 p<0.001）。右前小开胸组患者首次下床活动时间和住院时间明显短于部分上胸骨切开组（p=0.005，p=0.001）。右前小开胸组的翻修手术发生率明显低于部分上胸骨切开组（p=0.046）。两组 30 天死亡率（p=1.000）和 1 年死亡率（p=0.543）无显著差异。右前小开胸组和部分上胸骨切开组的 4 年 Kaplan-Meier 生存估计分别为 96.3%和 92.7%（对数秩检验 0.169）。
尽管存在技术挑战，但右前小开胸术仍可作为孤立性主动脉瓣置换术的一线策略。对于不适合该技术的患者，部分上胸骨切开术仍然是一种安全的方法，可以由广泛的外科医生进行。
