Perioperative Outcomes of Minimally Invasive Aortic Valve Replacement through Right Anterior Minithoracotomy
| Autor: | Kamil Fijorek, Jarosław Stoliński, Janusz Andres, Paweł Kruszec, Dariusz Plicner, Grzegorz Grudzień, Robert Musiał |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
Reoperation Pulmonary and Respiratory Medicine Aortic valve medicine.medical_specialty Time Factors medicine.medical_treatment Aortic Valve Insufficiency law.invention Postoperative Complications Aortic valve replacement Risk Factors law medicine.artery Ascending aorta medicine Humans Aged Retrospective Studies Aged 80 and over Heart Valve Prosthesis Implantation business.industry Retrospective cohort study Aortic Valve Stenosis Perioperative Length of Stay Middle Aged medicine.disease Conversion to Open Surgery Sternotomy Intensive care unit Surgery Treatment Outcome medicine.anatomical_structure Thoracotomy Median sternotomy Aortic Valve Female Clinical Competence Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business Complication Learning Curve |
| Popis: | Background The aim of the study was to analyze perioperative outcomes after minimally invasive aortic valve replacement through right anterior minithoracotomy (RAT-AVR). Patient selection criteria, anesthesia protocol, and surgical technique are presented. Methods A retrospective analysis of 194 patients electively scheduled for RAT-AVR was performed between January 2009 and June 2013. For preoperative planning, computed tomography was performed. Results Among studied patients, there were 48.5% females and 51.5% males with a mean age of 69.9 ± 9.2 years. The predicted mortality calculated with EuroSCORE II was 3.2 ± 0.9%, and observed mortality of RAT-AVR patients was 1.5%. Finally, RAT-AVR surgery was performed on 97.9% of patients ( n = 190). Reasons for conversions to median sternotomy were bleeding from aortotomy site ( n = 4) and from the right ventricle after epicardial pacing wire placement ( n = 1), pleural adhesions ( n = 2), and ascending aorta hidden under the sternum ( n = 2). The second intercostal space was chosen for surgical access in 97.9% of patients. There were 3.6% reoperations for bleeding: aortotomy place ( n = 1), epicardial pacing wire placement ( n = 3), right lung tear ( n = 2), and intercostal vessels ( n = 1). The intensive care unit and hospital length of stays were 1.3 ± 1.2 and 5.7 ± 1.4 days, respectively. Strokes were present in 1.5% of patients. The perioperative complications rate diminished with time, occurring in 44.9% of the patients between 2009 and 2010 and in 15.6% of patients in 2013. Conclusions RAT-AVR can be safely performed without increased morbidity and mortality. Reduced complication rates over time reflect a learning curve. |
| Databáze: | OpenAIRE |
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