Facilitating technologies in minimally invasive aortic valve replacement: a propensity score analysis.

ABSTRACT

OBJECTIVES: Minimally invasive aortic valve replacement (MIAVR) can be technically demanding and may lead to prolonged operative time. We evaluated the intraoperative and postoperative patient outcomes following implementation of 2 facilitating technologies (FT) in MIAVR the Cor-Knot titanium fastener and Custodiol-histidine-tryptophan-ketoglutarate solution. METHODS: A total of 299 patients underwent MIAVR from 2008 to 2016; 172 (57.5%) patients were included in the FT group and 127 (42.5%) patients in the control group (No-FT). We performed a propensity score analysis, matching 94 pairs. Primary end points were cardiopulmonary bypass and cross-clamp times. Secondary end points were blood product utilization, postoperative ejection fraction, intensive care unit and hospital lengths of stay, the in-hospital mortality rate and the incidence of stroke, sepsis, renal failure, atrial fibrillation, pulmonary embolism, pneumonia and prolonged mechanical ventilator support. RESULTS: The 2 matched groups had similar baseline characteristics. Significant reductions in cardiopulmonary bypass (104 ± 22 vs 118 ± 30 min, P < 0.001) and cross-clamp times (78 ± 17 vs 90 ± 21 min, P < 0.001) were noted in the FT group. Intraoperative red blood cell and cryoprecipitate transfusions (P < 0.001), prolonged mechanical ventilator support (P = 0.013), postoperative renal failure (P = 0.031) and hospital length of stay (P = 0.002) were all significantly decreased. There was insufficient evidence to detect a difference in postoperative ejection fraction, stroke, sepsis, pneumonia, pulmonary embolism or atrial fibrillation (P > 0.49). CONCLUSIONS: FT decreased intraoperative times, intraoperative red blood cell and cryoprecipitate transfusions, the need for prolonged mechanical ventilator support, renal failure and hospital length of stay. Using FT in MIAVR will allow for more reproducible, widespread adoption of minimally invasive approaches for aortic valve replacement.