Mini-aortic surgery with percutaneous cannulation and rapid-deployment valve.
BACKGROUND
We aimed to evaluate the results of the combined use of rapid-deployment valves, percutaneous cardioplegia delivery and left heart venting during minimally invasive aortic valve replacement surgery.


METHODS
We identified 2 propensity-matched cohorts of patients who underwent primary elective isolated minimally invasive aortic valve surgery at our center over a 3-years period: 30 patients in group A had a conventional valve prosthesis and 30 patients in group B received a rapid-deployment valve using percutaneous cardioplegia delivery and percutaneous left heart venting. Skin incision length, intraoperative times, postoperative hospital outcomes, and 30-day echocardiographic results were compared between the 2 groups.


RESULTS
Patients in group B had significantly shorter operative times and shorter skin incisions compared to group A (total operative time 196.0 ± 40.6 vs. 225.1 ± 30.8 min, respectively, p < 0.003; cardiopulmonary bypass time 79.9 ± 10.6 vs. 92.9 ± 17.2 min respectively, p < 0.001; crossclamp time 52.3 ± 9.6 vs. 74.9 ± 10.2 min, respectively, p < 0.001; incision length 3.6 ± 0.5 vs. 6.0 ± 0.6 cm, respectively, p < 0.001). Postoperative hospital outcomes and echocardiographic evaluation showed no significant differences.


CONCLUSIONS
The combined use of rapid-deployment valves, percutaneous cardioplegia, and left heart venting is safe and effective and allows a significant reduction of the skin incision together with a significant reduction of intraoperative times without affecting hospital outcomes or hemodynamic performance of the prosthetic valves.
Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
Piergiorgio
P
Bruno
Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
Piero
P
Farina
Department of Cardiovascular Sciences, Catholic University, Rome, Italy fcammer@gmail.com.
Federico
F
Cammertoni
Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
Raoul
R
Biondi
Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
Gianluigi
G
Perri
Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
Alessandro
A
Di Cesare
Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
Filippo
F
Crea
Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
Massimo
M
Massetti
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002315:Cardiopulmonary Bypass; D004452:Echocardiography; D005260:Female; D006324:Heart Arrest, Induced; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D057216:Propensity Score; D011474:Prosthesis Design; D012189:Retrospective Studies; D012384:Rome; D013997:Time Factors; D016896:Treatment Outcome
Aortic valve; Cardiac surgical procedures; Heart valve prosthesis implantation; Minimally invasive surgical procedures; Sternotomy