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More for less — Long-Term Survival Modelling for Surgical Aortic Valve Replacement follow-up. The division between a ministernotomy and a full sternotomy approach

Marcin Kaczmarczyk1, Marian Zembala1, Aleksandra Kaczmarczyk2, Krzysztof Filipiak3, Tomasz Hrapkowicz1, Jerzy Pacholewicz1, Michał Zembala23
DOI: 10.33963/KP.a2022.0056
·
Pubmed: 35188218
Affiliations
  1. Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery, Faculty of Medical Scie
  2. Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, University Clinical Center, Katowice, Poland
  3. Department of Cardiac Surgery, Pomeranian Medical University, Independent Public Clinical Hospital No. 2, Szczecin, Poland

open access

Online first
Original article
Published online: 2022-02-21

Abstract

Background: The aims of this study were to assess long-term results after surgical AVR (sAVR) depending on the surgical technique used (ministernotomy vs. full sternotomy) and to determine in parallel, which patient- and treatment-related attributes were most associated with shorter time to the main endpoint.

Methods: Out of 2147 patients, who underwent sAVR from January 2006 to December 2017, 615 patients were treated minimally invasively (MIAVR) and 1532 patients received conventional full sternotomy aortic valve replacement (FSAVR). Multiple Cox regressive models corresponding to the four major endpoints were developed. Long-term survival and a time to re-hospitalization for acute coronary syndrome, stroke and heart failure (HF) have been analyzed, independently. Kaplan-Meier actuarial analysis was performed for univariate comparison.

Results: The median follow-up time was 71.9 months. No significant difference in terms of long-term survival was found between MIAVR and FSAVR (hazard ratio [HR], 0.99; P = 0.91). Novel advantages of MIAVR in preventing from re-hospitalization for the late cerebrovascular event and the progress of HF have been observed (HR, 0.53; P = 0.03; HR, 0.64, P = 0.005; respectively). Importantly, for the late mortality risk early in-hospital complications dominate. However, the baseline atrial fibrillation (AF), diabetes, pulmonary disease and impaired mobility show the strongest patient-specific prediction for the other three long-run models.

Conclusions: MIAVR through ministernotomy provides at least as good long-term survival as FSAVR. Nevertheless, it should be recommended for diabetic, poor mobility patients with pre-existing AF in order to reduce their high cerebrovascular risk and to limit the progression of HF. MIAVR also needs to be considered in patients with chronic lung diseases to improve their extremely poor survival prognosis.

 

Abstract

Background: The aims of this study were to assess long-term results after surgical AVR (sAVR) depending on the surgical technique used (ministernotomy vs. full sternotomy) and to determine in parallel, which patient- and treatment-related attributes were most associated with shorter time to the main endpoint.

Methods: Out of 2147 patients, who underwent sAVR from January 2006 to December 2017, 615 patients were treated minimally invasively (MIAVR) and 1532 patients received conventional full sternotomy aortic valve replacement (FSAVR). Multiple Cox regressive models corresponding to the four major endpoints were developed. Long-term survival and a time to re-hospitalization for acute coronary syndrome, stroke and heart failure (HF) have been analyzed, independently. Kaplan-Meier actuarial analysis was performed for univariate comparison.

Results: The median follow-up time was 71.9 months. No significant difference in terms of long-term survival was found between MIAVR and FSAVR (hazard ratio [HR], 0.99; P = 0.91). Novel advantages of MIAVR in preventing from re-hospitalization for the late cerebrovascular event and the progress of HF have been observed (HR, 0.53; P = 0.03; HR, 0.64, P = 0.005; respectively). Importantly, for the late mortality risk early in-hospital complications dominate. However, the baseline atrial fibrillation (AF), diabetes, pulmonary disease and impaired mobility show the strongest patient-specific prediction for the other three long-run models.

Conclusions: MIAVR through ministernotomy provides at least as good long-term survival as FSAVR. Nevertheless, it should be recommended for diabetic, poor mobility patients with pre-existing AF in order to reduce their high cerebrovascular risk and to limit the progression of HF. MIAVR also needs to be considered in patients with chronic lung diseases to improve their extremely poor survival prognosis.

 

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Keywords

minimally invasive aortic valve replacement, ministernotomy, mini-invasive cardiac surgery, long-term outcomes, independent predictors

About this article
Title

More for less — Long-Term Survival Modelling for Surgical Aortic Valve Replacement follow-up. The division between a ministernotomy and a full sternotomy approach

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-02-21

Page views

65

Article views/downloads

55

DOI

10.33963/KP.a2022.0056

Pubmed

35188218

Keywords

minimally invasive aortic valve replacement
ministernotomy
mini-invasive cardiac surgery
long-term outcomes
independent predictors

Authors

Marcin Kaczmarczyk
Marian Zembala
Aleksandra Kaczmarczyk
Krzysztof Filipiak
Tomasz Hrapkowicz
Jerzy Pacholewicz
Michał Zembala

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