title: Minimally invasive and conventional aortic valve replacement: a propensity score analysis.
abstract: BACKGROUND
  The study aimed to compare the short-term results of aortic valve replacement through minimally invasive and sternotomy approaches.
  
  
  METHODS
  This is a retrospective, observational, cohort study of prospectively collected data on 709 patients undergoing isolated primary aortic valve replacement between 2004 and 2011. Of these, 338 were performed through either right anterior minithoracotomy or upper ministernotomy. With propensity score matching, 182 patients (minimally invasive group) were compared with 182 patients in conventional sternotomy (control group).
  
  
  RESULTS
  After propensity matching, the 2 groups were comparable in terms of preoperative characteristics. Cardiopulmonary bypass time (117.5 vs 104.1 min, p<0.0001) and aortic cross-clamping time (83.8 vs 71.3 min, p<0.0001) were longer in the minimally invasive group, with no difference in length of stay (median 6 vs 5 days, p=0.43), but shorter assisted ventilation time (median 8 vs 7 hours, p=0.022). Overall in-hospital mortality was identical between the groups (1.64 vs 1.64%, p=1.0). No difference in the incidence of major and minor postoperative complications and related morbidity was observed. Minimally invasive aortic valve replacement was associated with a lower incidence of new onset postoperative atrial fibrillation (21% vs 31%, p=0.04). Reduction of the complication rate was observed. Median transfusion pack per patient was higher in the control group (2 vs 1 units, p=0.04).
  
  
  CONCLUSIONS
  Our experience shows that mini-access isolated aortic valve surgery is a reproducible, safe, and effective procedure and reduces assisted ventilation duration, the need for blood product transfusion, and incidence of post-surgery atrial fibrillation.
authors.affiliation: Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa, Italy. drgilmanov@hotmail.it
authors.forename: Daniyar
authors.initials: D
authors.lastname: Gilmanov
authors.forename: Stefano
authors.initials: S
authors.lastname: Bevilacqua
authors.forename: Michele
authors.initials: M
authors.lastname: Murzi
authors.forename: Alfredo G
authors.initials: AG
authors.lastname: Cerillo
authors.forename: Tommaso
authors.initials: T
authors.lastname: Gasbarri
authors.forename: Enkel
authors.initials: E
authors.lastname: Kallushi
authors.forename: Antonio
authors.initials: A
authors.lastname: Miceli
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D002315:Cardiopulmonary Bypass / Q000379:methods / Q000401:mortality; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D061214:Patient Safety; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods*; D016019:Survival Analysis; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: 35; AF; AVR; CAVR; CI; COPD; CPB; CVA; ICU; MIAVR; OR; aortic valve replacement; atrial fibrillation; cardiopulmonary bypass; cerebrovascular accident; chronic obstructive pulmonary disease; confidence interval; conventional aortic valve replacement; intensive care unit; minimally invasive aortic valve replacement; odds ratio