Early Outcomes of Minimally Invasive Right Anterior Thoracotomy vs. Median Full Sternotomy in Isolated Aortic Valve Replacement: A Propensity Score Analysis.

INTRODUCTION: This study aimed to compare the early postoperative outcomes of right anterior thoracotomy minimally invasive aortic valve replacement (RAT-MIAVR) surgery with those of median full sternotomy aortic valve replacement (MFS-AVR) approach with the goal of identifying potential benefits or drawbacks of each technique. METHODS: This retrospective, observational, cohort study included 476 patients who underwent RAT-MIAVR or MFS-AVR in our hospital from January 2015 to January 2023. Of these, 107 patients (22.5%) underwent RAT-MIAVR, and 369 patients (77.5%) underwent MFS-AVR. Propensity score matching was used to minimize selection bias, resulting in 95 patients per group for analysis. RESULTS: After propensity matching, two groups were comparable in preoperative characteristics. RAT-MIAVR group showed longer cardiopulmonary bypass time (130.24 ± 31.15 vs. 117.75 ± 36.29 minutes, P=0.012), aortic cross-clamping time (76.44 ± 18.00 vs. 68.49 ± 19.64 minutes, P=0.004), and longer operative time than MFS-AVR group (358.47 ± 67.11 minutes vs. 322.42 ± 63.84 minutes, P=0.000). RAT-MIAVR was associated with decreased hospitalization time after surgery, lower postoperative blood loss and drainage fluid, a reduced incidence of mediastinitis, increased left ventricular ejection fraction, and lower pacemaker use compared to MFS-AVR. However, there was no significant difference in the incidence of major complications and in-hospital mortality between the two groups. CONCLUSION: RAT-MIAVR is a feasible and safe alternative procedure to MFS-AVR, with comparable in-hospital mortality and early follow-up. This minimally invasive approach may be a suitable option for patients requiring isolated aortic valve replacement.

Early Outcomes of Minimally Invasive Right Anterior Thoracotomy vs. Median Full Sternotomy in Isolated Aortic Valve Replacement: A Propensity Score Analysis

ABSTRACT Introduction: This study aimed to compare the early postoperative outcomes of right anterior thoracotomy minimally invasive aortic valve replacement (RAT-MIAVR) surgery with those of median full sternotomy aortic valve replacement (MFS-AVR) approach with the goal of identifying potential benefits or drawbacks of each technique. Methods: This retrospective, observational, cohort study included 476 patients who underwent RAT-MIAVR or MFS-AVR in our hospital from January 2015 to January 2023. Of these, 107 patients (22.5%) underwent RAT-MIAVR, and 369 patients (77.5%) underwent MFS-AVR. Propensity score matching was used to minimize selection bias, resulting in 95 patients per group for analysis. Results: After propensity matching, two groups were comparable in preoperative characteristics. RAT-MIAVR group showed longer cardiopulmonary bypass time (130.24 ± 31.15 vs. 117.75 ± 36.29 minutes, P=0.012), aortic cross-clamping time (76.44 ± 18.00 vs. 68.49 ± 19.64 minutes, P=0.004), and longer operative time than MFS-AVR group (358.47 ± 67.11 minutes vs. 322.42 ± 63.84 minutes, P=0.000). RAT-MIAVR was associated with decreased hospitalization time after surgery, lower postoperative blood loss and drainage fluid, a reduced incidence of mediastinitis, increased left ventricular ejection fraction, and lower pacemaker use compared to MFS-AVR. However, there was no significant difference in the incidence of major complications and in-hospital mortality between the two groups. Conclusion: RAT-MIAVR is a feasible and safe alternative procedure to MFS-AVR, with comparable in-hospital mortality and early follow-up. This minimally invasive approach may be a suitable option for patients requiring isolated aortic valve replacement.

Preoperative Immature Neutrophils Predict Clinical Outcomes in Patients with Uncomplicated Type-B Aortic Dissection After Thoracic Endovascular Aortic Repair.

Purpose: Inflammation is a hallmark of the initial development and progression of aortic dissection. This study aimed to investigate the predictive value of preoperative neutrophils in aorta-related adverse events (AAEs) after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). Patients and Methods: A total of 80 patients with TBAD undergoing TEVAR were enrolled in our hospital. Preoperative inflammatory markers, including white blood cells (WBCs), neutrophils, neutrophil-to-lymphocyte ratio (NLR) and plasma high-sensitivity C-reactive protein (hs-CRP), were measured. Circulating neutrophil subpopulation was determined by flow cytometry. Kaplan-Meier curve was performed to determine whether neutrophil subsets independently predicted aorta-related adverse events (AAEs) after TEVAR. Results: Compared with control group, the prevalence of hypertension and the levels of inflammatory indicators including WBCs, total neutrophils, NLR, immature neutrophils and hs-CRP were significantly higher in TBAD patients. Receiver operating characteristic (ROC) curve showed that NLR, absolute number of total neutrophils and percent CD10- immature neutrophils had excellent area under curves. During the 18-month follow-up, 16 (20.0%) were reported to occur AAEs, while 4 deaths (5.0%) were documented. Percent immature neutrophil was markedly higher in TBAD patients experiencing AAEs as compared with those without AAEs. Kaplan-Meier curve and Cox regression analysis demonstrated that percent immature neutrophil was the only predictor correlated with the occurrence of AAEs (hazard ratio 7.66, 95% CI: 2.91, 20.17, P = 0.018). Conclusion: Increased CD10- immature neutrophils could act as a potential biomarker related to long-term adverse outcomes in TBAD patients following TEVAR.

Septal Myectomy and Subvalvular Repair in Hypertrophic Cardiomyopathy, a Systematic Review and Pooled Analysis.

Background: Some patients with hypertrophic obstructive cardiomyopathy (HOCM) still exhibit systolic anterior motion (SAM) and mitral regurgitation (MR) even after undergoing an isolated ventricular septectomy. Currently, there are disputes regarding whether to perform a mitral valve intervention and which type of operation is more effective. Methods: By searching PubMed, Cochrane, Embase, Web of Science, FDA.gov, and ClinicalTrials.gov, as well as other resource databases, we obtained all articles published before December 2022 on ventricular septal myectomy combined with mitral valve intervention for hypertrophic cardiomyopathy. Demographic information and outcome variable data were extracted from 10 screened studies on ventricular septal resection combined with mitral valve repair. The risk of bias was assessed using methodological index for non-randomized studies (MINORS). Student's t-test was used for comparisons of continuous variables, and the chi-square or Fisher's exact test was used for dichotomous variables. A total of 692 patients across 10 studies were analyzed. Results: There were 5 (0.7%) deaths in the perioperative period. The average cardiopulmonary bypass time was 64.7 ± 22.2 minutes, and the average follow-up time was 39.6 ± 36.3 months. Compared with baseline levels, the left ventricular outflow tract gradient (83.6 ± 32.2 mmHg vs. 11.0 ± 7.8 mmHg, p < 0.01), maximum interventricular septal thickness (22.5 ± 5.1 mm vs. 14.7 ± 5.5 mm, p < 0.01), III/IV mitral regurgitation (351/692 vs. 17/675, p < 0.01), anterior mitral leaflet (AML)-annulus ratio (0.49 ± 0.14 vs. 0.60 ± 0.12, p < 0.01), tenting area (2.72 ± 0.60 cm 2 vs. 1.95 ± 0.60 cm 2 , p < 0.01), and SAM (181/194 vs. 11/215, p < 0.01) were significantly improved. 14 (2.1%) patients were in New York Heart Association functional class III/IV, which was significantly improved compared with the preoperative state (541/692 vs. 14/682, p < 0.01). Conclusions: Ventricular septectomy combined with mitral valve repair can be a safe and effective treatment option for patients suffering from HOCM with SAM and severe MR.