Propensity-score matched comparison between minimally invasive and conventional aortic valve replacement

Scientific paper - Original scientific paper

• Author: Hrvoje Gašparović
• Author: Petra Čerina
• Author: Tomislav Tokić
• Author: Marjan Urlić
• Author: Branka Golubić Ćepulić
• Author: Tomislav Kopjar
• Author: Ivan Burcar
• Author: Bojan Biočina
• Author's institution: University of Zagreb; School of Medicine; (Department of Surgery)
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract (english)

Aim: To evaluate the impact of minimally invasive aortic valve replacement (mini-AVR) on clinical outcomes in comparison with the gold standard.
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Methods: We retrospectively reviewed the records of all patients who underwent isolated AVR at the University Hospital Center Zagreb from 2010 to 2020. Patients undergoing mini-AVR were compared with patients undergoing conventional AVR (fs-AVR). The primary outcome measure was blood product consumption. Propensity score matching was used to create a balanced covariate distribution across treatment groups. Additionally, we compared the contemporary outcomes with a historical control.
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Results: The final sample consisted of 1088 patients. In the unmatched cohorts, mini-AVR patients were younger (65±12 vs 68±10 years, P<0.001) and had lower risk profiles (EuroSCORE2 2.8±2.0 vs 3.5±3.1, P=0.003). After matching, mini-AVR patients required less blood transfusion than fs-AVR patients (270 [0-790] vs 510 [0-970] mL, P=0.029). The incidences of stroke, dialysis, new AV block, and mortality were comparable. Cross-clamp times were longer in the mini-AVR group (71 [60-87] vs 66 [53-83] minutes, P=0.013). Outcomes were improved in the contemporary mini-AVR era compared with our early mini-AVR experience across multiple metrics. Blood product consumption was reduced in the latter tercile of experience (0 [0-520] vs 500 [0-1018] mL, P<0.001), and the operation was performed more expeditiously (cross-clamp times: 63 [54,80] vs 74 [62,88] minutes, P<0.001) in comparison with earlier periods.
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Conclusions: We showed that mini-AVR was associated with less blood product requirement than conventional surgery. Our data supports wider adoption of minimally invasive techniques in dedicated centers of excellence.

• Keywords (english): Aortic Valve / surgery; Heart Valve Prosthesis Implantation / methods; Humans; Minimally Invasive Surgical Procedures / methods; Propensity Score; Retrospective Studies; Sternotomy / methods; Treatment Outcome
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Croatian Medical Journal
• Numbering: vol. 63, no. 5, pp. 423-430
• p-ISSN: 0353-9504
• e-ISSN: 1332-8166
• DOI: https://doi.org/10.3325/cmj.2022.63.423
• URN:NBN: urn:nbn:hr:105:877511
• Publication: 2022-10-31
• Document URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9648077/
• Type of resource: Text
• Access conditions: Open access
• Created on: 2022-12-06 09:59:06