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Propensity matched analysis of minimally invasive versus conventional isolated aortic valve replacement
Perfusion ( IF 1.2 ) Pub Date : 2021-09-13 , DOI: 10.1177/02676591211045802
Shwe Oo 1 , Amilah Khan 1 , Jeremy Chan 1 , Sanjay Juneja 1 , Massimo Caputo 1 , Gianni Angelini 1 , Cha Rajakaruna 1 , Hunaid A Vohra 1
Affiliation  

Objective:

To analyse the early and mid-term outcome of patients undergoing conventional aortic valve replacement (AVR) versus minimally invasive via hemi-sternotomy aortic valve replacement (MIAVR).

Methods:

A single centre retrospective study involving 653 patients who underwent isolated aortic valve replacement (AVR) either via conventional AVR (n = 516) or MIAVR (n = 137) between August 2015 and March 2020. Using pre-operative characteristics, patients were propensity matched (PM) to produce 114 matched pairs. Assessment of peri-operative outcomes, early and mid-term survival and echocardiographic parameters was performed.

Results:

The mean age of the PM conventional AVR group was 71.5 (±8.9) years and the number of male (n = 57) and female (n = 57) patients were equal. PM MIAVR group mean age was 71.1 (±9.5) years, and 47% of patients were female (n = 54) and 53% male (n = 60). Median follow-up for PM conventional AVR and MIAVR patients was 3.4 years (minimum 0, maximum 4.8 years) and 3.4 years (minimum 0, maximum 4.8 years), respectively. Larger sized aortic valve prostheses were inserted in the MIAVR group (median 23, IQR = 4) versus conventional AVR group (median 21, IQR = 2; p = 0.02, SMD = 0.34). Cardiopulmonary bypass (CPB) time was longer with MIAVR (94.4 ± 19.5 minutes) compared to conventional AVR (83.1 ± 33.3; p = 0.0001, SMD = 0.41). Aortic cross-clamp (AoX) time was also longer in MIAVR (71.6 ± 16.5 minutes) compared to conventional AVR (65.0 ± 52.8; p = 0.0001, SMD = 0.17). There were no differences in the early post-operative complications and mortality between the two groups. Follow-up echocardiographic data showed significant difference in mean aortic valve gradients between conventional AVR and MIAVR groups (17.3 ± 8.2 mmHg vs 13.0 ± 5.1 mmHg, respectively; p = 0.01, SMD = −0.65). There was no significant difference between conventional AVR and MIAVR in mid-term survival at 3 years (88.6% vs 92.1%; log-rank test p = 0.31).

Conclusion:

Despite the longer CPB and AoX times in the MIAVR group, there was no significant difference in early complications, mortality and mid-term survival between MIAVR and conventional AVR.



中文翻译:

微创与传统隔离主动脉瓣置换术的倾向匹配分析

客观的:

分析接受常规主动脉瓣置换术 (AVR) 与微创半胸骨切开术主动脉瓣置换术 (MIAVR) 患者的早期和中期结果。

方法:

一项单中心回顾性研究,涉及 653 名在 2015 年 8 月至 2020 年 3 月期间通过传统 AVR(n  = 516)或 MIAVR(n  = 137)接受孤立主动脉瓣置换术 (AVR) 的患者。使用术前特征,对患者进行倾向匹配(PM) 产生 114 对配对。对围手术期结果、早期和中期生存和超声心动图参数进行了评估。

结果:

PM 常规 AVR 组的平均年龄为 71.5 (±8.9) 岁,男性 ( n  = 57) 和女性 ( n = 57) 患者人数 相等。PM MIAVR 组平均年龄为 71.1 (±9.5) 岁,47% 的患者为女性 ( n  = 54),53% 的患者为男性 ( n = 60)。PM 常规 AVR 和 MIAVR 患者的中位随访时间分别为 3.4 年(最短 0 年,最长 4.8 年)和 3.4 年(最短 0 年,最长 4.8 年)。与传统 AVR 组(中位数 21,IQR = 2;p = 0.02,SMD = 0.34)相比,MIAVR 组(中位数 23,IQR = 4)插入了更大尺寸的主动脉瓣假体。与传统 AVR (83.1 ± 33.3;p = 0.0001,SMD = 0.41) 相比,MIAVR 的心肺旁路 (CPB) 时间更长(94.4 ± 19.5 分钟)。与传统 AVR (65.0 ± 52.8;p = 0.0001,SMD = 0.17) 相比,MIAVR 的主动脉钳夹 (AoX) 时间也更长(71.6 ± 16.5 分钟)。两组术后早期并发症和死亡率无差异。随访超声心动图数据显示,常规 AVR 组和 MIAVR 组的平均主动脉瓣压力梯度存在显着差异(分别为 17.3 ± 8.2 mmHg 和 13.0 ± 5.1 mmHg;p = 0.01,SMD = −0.65)。常规 AVR 和 MIAVR 在 3 年中期生存率方面没有显着差异(88.6% 对 92.1%;对数秩检验 p = 0.31)。

结论:

尽管 MIAVR 组的 CPB 和 AoX 时间更长,但 MIAVR 和常规 AVR 之间的早期并发症、死亡率和中期生存率没有显着差异。

更新日期:2021-09-13
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