Aortic Valve Replacement: Totally Endoscopic versus Mini-Sternotomy.

(1) Background: The development of totally endoscopic aortic valve replacement has the potential to enhance clinical results compared to mini-sternotomy. To our knowledge, no comparison between these two techniques has been conducted before. Therefore, the objective of this retrospective study is to examine the results after both totally endoscopic and mini-sternotomy approaches. (2) Methods: This study covered all elective patients who underwent isolated aortic valve replacement, either totally endoscopically (n = 392) or through a mini-sternotomy (n = 323), between 2013 and 2021. Multivariable analysis was used to account for baseline variations between the two groups. All data were retrospectively gathered and analysed. The primary objective of this study was the one-year mortality rate. (3) Results: The mean aortic cross-clamping and cardiopulmonary bypass times were significantly longer in the totally endoscopic approach (cross-clamping: 43.73 ± 13.71 min and 61.93 ± 16.76 min, p-value < 0.001; CPB time: 64.86 ± 23.02 min and 93.23 ± 23.67 min, p-value < 0.001). However, perioperative bleeding was lower (706.40 ± 542.77 mL and 444.50 ± 515.84 mL, p-value < 0.001). The primary objective, one-year survival, did not significantly differ between both groups (Mini-AVR: 94.5% vs TEAVR: 93.3%, p-value = 0.520). (4) Conclusions: Our results show that totally endoscopic aortic valve replacement has comparable clinical results compared to aortic valve replacement through mini-sternotomy.

Patient-Centred Outcomes after Totally Endoscopic Cardiac Surgery: One-Year Follow-Up.

Patient-centred outcomes have grown in popularity over recent years in surgical care research. These patient-centred outcomes can be measured through the health-related quality of life (HRQL) without professional interpretations. In May 2022, a study regarding patient-centred outcomes up to 90 days postoperatively was published. Fourteen days after surgery, the HRQL decreased and returned to baseline levels after 30 days. Next, the HRQL significantly improved 90 days postoperatively. However, this study only focuses on a short-term follow-up of the patients. Hence, this follow-up study aims to assess the HRQL one year after totally endoscopic cardiac surgery. At baseline, 14, 30, and 90 days, and one year after surgery, the HRQL was evaluated using a 36-item short form and 5-dimensional European QoL questionnaires (EQ-5D). Using the 36-item short form questionnaire, a physical and mental component score is calculated. Over the period of one year, this physical and mental component score and the EQ-5D index value significantly improve. According to the visual analogue scale of the EQ-5D, patients score their health significantly higher one year postoperatively. In conclusion, after endoscopic cardiac surgery, the HRQL is significantly improved 90 days postoperatively and remains high one year afterward.

Serratus plane block versus standard of care for pain control after totally endoscopic aortic valve replacement: a double-blind, randomized controlled, superiority trial.

INTRODUCTION: Serratus anterior plane block has been proposed to reduce opioid requirements after minimally invasive cardiac surgery, but high-quality evidence is lacking. METHODS: This prospective, double-blinded, randomized controlled trial recruited patients undergoing totally endoscopic aortic valve replacement. Patients in the intervention arm received a single-injection serratus anterior plane block on arrival to the intensive care unit added to standard of care. Patients in the control group received routine standard of care, including patient-controlled intravenous analgesia. Primary outcome was piritramide consumption within the first 24 hours after serratus anterior plane block placement. We hypothesized that compared with no block, patients in the intervention arm would consume 25% less opioids. RESULTS: Seventy-five patients were analyzed (n=38 in intervention arm, n=37 in control arm). When comparing the serratus anterior plane group with the control group, median 24-hour cumulative opioid use was 9 (IQR 6-19.5) vs 15 (IQR 11.3-23.3) morphine milligram equivalents, respectively (p<0.01). Also, pain scores at 4, 8 and 24 hours were lower in the intervention arm at 4, 8 and 24 hours, respectively. CONCLUSION: Combined deep and superficial single-injection serratus anterior plane block is superior to standard of care in reducing opioid requirements and postoperative pain intensity up to 24 hours after totally endoscopic aortic valve replacement. TRIAL REGISTRATION NUMBER: NCT04699422.

A totally endoscopic approach for aortic valve surgery.

OBJECTIVES: Our goal was to describe a new approach for totally endoscopic aortic valve replacement. METHODS: From October 2017 through December 2020, a total of 266 consecutive patients underwent totally endoscopic aortic valve replacement. Reoperations and combinations were excluded. RESULTS: A total of 266 patients with a median age of 72 (64, 79) years underwent totally endoscopic aortic valve replacement; of these, 250 (93.98%) patients were designated to undergo surgery because of aortic valve stenosis. The median follow-up index was 0.69 (0.30, 0.90). Major adverse cardiac and cerebrovascular events occurred in 4 (1.50%) patients within 30 days. Overall hospital mortality was 1.50%. Twenty additional deaths (7.52%) occurred during the 3-year follow-up period. An early thoracoscopic revision was needed in 7 patients due to signs of bleeding or cardiac tamponade. Fourteen patients required a permanent pacemaker implant. CONCLUSIONS: Retrospective analysis of our early experience with totally endoscopic aortic valve replacement in 266 consecutive patients demonstrated satisfactory results, with low mortality and acceptable morbidity rates.

90-Day Patient-Centered Outcomes after Totally Endoscopic Cardiac Surgery: A Prospective Cohort Study.

Over the past years, minimally invasive procedures have been developed to reduce surgical trauma after cardiac surgery. The value of patient-centered outcomes, including the quality of recovery after hospital discharge, is increasingly recognized. Identifying meaningful changes in postoperative function that might have a negative impact on patients without noticeable complications can provide a more comprehensive understanding of the impact on the patient's life. In total, 209 patients were included in this trial. Of these, 193 patients underwent totally endoscopic cardiac surgery, 8 underwent cardiac surgery through a sternotomy, and 8 underwent transcatheter aortic valve implantation. Patients who previously underwent cardiac surgery were excluded. Quality of life was determined through the Short Form 36 and European Quality of Life-5 Dimensions questionnaires before the surgery and 14, 30, and 90 days afterward. In patients who underwent totally endoscopic cardiac surgery, the quality of life improved over the three time periods. The different domains of the questionnaire evolved in a positive manner. However, 14 days postoperatively, a decline in quality of life was noted, followed by a return to baseline at 30 days and an increase at 90 days. In conclusion, totally endoscopic cardiac surgery improves the quality of life 90 days after surgery.