Minimally Invasive Extracorporeal Bypass in Minimally Invasive Heart Valve Operations: A Prospective Randomized Trial.
BACKGROUND
Minimally invasive extracorporeal circulation (MECC) is predominantly used in coronary operations. Data supporting the benefits of MECC in minimally invasive valve operations are still absent.


METHODS
Patients undergoing either isolated minimally invasive mitral or aortic valve procedures were prospectively randomized to a minimally invasive group (MECC; n = 101) or a conventional extracorporeal circulation group (CECC; n = 99). The procedural and postoperative outcomes were compared, including the levels of inflammation factors (procalcitonin, interleukin [IL]-6, IL-8, and IL-10), tumor necrosis factor-α [TNF-α], and interferon-gamma [IFN-γ]).


RESULTS
The demographics were comparable between the groups regarding age (MECC versus CECC, 70.5 ± 10.2 years versus 73.1 ± 8.9 years; P = 0.086), left ventricular function (59.2% ± 13.4% versus 62.1% ± 14.0%; p = 0.302), EuroSCORE (7.4% ± 7.9% versus 6.8% ± 4.0%; p = 0.256), and other comorbidities. Hospital mortality (n = 1 versus n = 3; p = 0.339) and other complications were similar. However, hemoglobin level (111.9 ± 19.0 g/L versus 103.8 ± 14.6 g/L; p = 0.001), the number of packed red blood cells (PRBCs) (1.1 ± 1.9 versus 1.7 ± 1.8; p = 0.003), the levels of ILs (IL-6, 194.0 ± 131.8 pg/mL versus 289.2 ± 62.5 pg/mL; p = 0.020; IL-8, 38.1 ± 27.3 pg/mL versus 45.8 ± 43.4 pg/mL; p = 0.012; IL-10, 29.0 ± 123.9 pg/mL versus 49.9 ± 85.6 pg/mL; p = 0.012), TNF-α (3.8 ± 6.7 ng/mL versus 10.8 ± 47.7 ng/mL; p = 0.049), and IFN-γ (1.9 ± 1.9 pg/mL versus 4.5 ± 2.7 pg/mL; p = 0.027) were in favor of patients in the MECC group. Additionally, those patients had shorter postoperative ventilation time (7.7 ± 8.4 hours versus 9.3 ± 12.9 hours; p = 0.010) and intensive care unit (ICU) stay (1.2 ± 1.2 days versus 2.2 ± 3.8 days; p = 0.047).


CONCLUSIONS
The intraprocedural data were excellent and comparable in the groups, but postoperative outcomes were better in the MECC group. Thus MECC is preferable to CECC even for minimally invasive valve procedures. These findings strongly support a combined strategy of minimally invasive valve operations and minimally invasive extracorporeal circulation.
Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
Hardy
H
Baumbach
Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany. Electronic address: christian.rustenbach@rbk.de.
Christian J
CJ
Rustenbach
Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
Samir
S
Ahad
Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
Ragi
R
Nagib
Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
Marc
M
Albert
Department of Clinical Chemistry and Laboratory Medicine, Robert Bosch Hospital, Stuttgart, Germany.
Dieter
D
Ratge
Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
Ulrich F W
UF
Franke
D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D016207:Cytokines / Q000097:blood; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000097:blood / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends
D015415:Biomarkers; D016207:Cytokines