Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy)
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Indicator | Overall Cohort | Propensity Score Matched Cohort | ||||
---|---|---|---|---|---|---|
Mini-Sternotomy n = 70 | Full Sternotomy n = 356 | p | Mini-Sternotomy n = 70 | Full Sternotomy n = 70 | p | |
Age, mean ± SD, years | 60.8 ± 11.6 | 63.3 ± 13.2 | 0.155 | 60.8 ± 11.6 | 61.4 ± 11.9 | 0.155 |
Male, n (%) | 42 (60.0) | 193 (54.2) | 0.384 | 42 (60) | 42 (60) | 1.000 |
Height, mean ± SD, cm | 170.8 ± 10.0 | 169.3 ± 10.2 | 0.247 | 170.8 ± 10.0 | 170.1 ± 9.0 | 0.247 |
Body weight, mean ± SD, kg | 82.3 ± 1.8 | 82.6 ± 1.8 | 0.886 | 82.3 ± 1.8 | 81.0 ± 1.6 | 0.886 |
BMI, mean ± SD, kg/m2 | 27.7 ± 4.4 | 28.8 ± 5.6 | 0.656 | 27.7 ± 4.4 | 27.9 ± 4.5 | 0.536 |
Diagnosis, n (%) | ||||||
Aortic stenosis | 51 (72.9) | 267 (75.2) | 0.822 | 51 (72.9) | 45 (64.3) | 0.754 |
Aortic regurgitation | 12 (17.1) | 50 (14.1) | 0.502 | 12 (17.1) | 13 (18.6) | 0.825 |
Combined | 7 (10.0) | 38 (10.7) | 0.763 | 7 (10.0) | 12 (17.1) | 0.217 |
Etiology of the disease, n (%) | ||||||
Senile degeneration | 53 (75.71) | 283 (80.4) | 0.350 | 53 (75.71) | 53 (75.71) | 1.000 |
Annular expansion | 13 (18.6) | 47(13.4) | 0.238 | 13 (18.6) | 12 (17.14) | 0.825 |
Mitral valve | 1 (1.4) | 0 (0.0) | 0.024 | 1 (1.4) | 0 (0.0) | 0.316 |
Infective endocarditis | 3 (4.3) | 22 (6.3) | 0.538 | 3 (4.3) | 5 (7.14) | 0.466 |
EuroSCORE II | ||||||
<1%, n (%) | 24 (34.3) | 99 (27.8) | 0.253 | 24 (34.3) | 20 (28.6) | 0.466 |
1–3%, n (%) | 44 (62.9) | 201 (56.5) | 0.344 | 44 (62.9) | 42 (60.0) | 0.728 |
>3%, n (%) | 2 (2.9) | 56 (15.7) | 0.004 | 2 (2.9) | 8 (11.4) | 0.049 |
NYHA functional class, n (%) | ||||||
II | 12 (17.14) | 41 (11.5) | 0.192 | 12 (17.14) | 6 (8.6) | 0.130 |
III | 57 (81.43) | 301 (84.6) | 0.514 | 57 (81.43) | 64 (91.4) | 0.084 |
IV | 1 (1.4) | 14 (3.9) | 0.299 | 1 (1.4) | 0 (0.0) | 0.316 |
Creatinine clearance (mL/min) | ||||||
<50, n (%) | 41 (58.6) | 3 (0.8) | 0.144 | 41 (58.6) | 36 (51.4) | 0.396 |
50–85, n (%) | 27 (38.6) | 196 (55.4) | 0.075 | 27 (38.6) | 31 (44.3) | 0.493 |
>85, n (%) | 2 (2.86) | 155 (43.8) | 0.098 | 2 (2.86) | 3 (4.3) | 0.649 |
Diabetes mellitus, n (%) | 11 (15.7) | 5 (7.1) | 0.111 | 11 (15.7) | 5 (7.1) | 0.111 |
COPD, n (%) | 4 (5.7) | 0 (0.0) | 0.042 | 4 (5.7) | 0 (0.0) | 0.042 |
Hypertension, n (%) | 22 (31.4) | 57 (16.1) | 0.003 | 22 (31.4) | 10 (16.0) | 0.016 |
Stroke, n (%) | 0 (0.0) | 16 (4.5) | 0.086 | 0 (0.0) | 2 (2.9) | 0.154 |
Coronary artery disease, n (%) | 3 (4.3) | 12 (3.4) | 0.723 | 3 (4.3) | 1 (1.4) | 0.310 |
Renal failure, n (%) | 2 (2.9) | 1 (1.4) | 0.5590.000 | 2 (2.9) | 1 (1.4) | 0.559 |
Pacemaker, n (%) | 5 (7.1) | 16 (4.5) | 1.000 | 5 (7.1) | 2 (2.9) | 0.245 |
LVEF %, n (%) | ||||||
<30% | 0 (0.0) | 0 (0.0) | ND | 0 (0.0) | 0 (0.0) | ND |
30–49% | 16 (22.9) | 11 (15.7) | 0.580 | 16 (22.9) | 11 (15.7) | 0.284 |
≥50% | 54 (77.1) | 59 (84.3) | 0.826 | 54 (77.1) | 59 (84.3) | 0.284 |
Indicator | Overall Cohort | Propensity Score Matched Cohort | ||||
---|---|---|---|---|---|---|
Full Sternotomy n = 356 | Mini-Sternotomy n = 70 | p | Full Sternotomy n = 70 | Mini-Sternotomy n = 70 | p | |
Surgery duration, mean ± standard deviation (SD), min | 246.7 ± 74.2 | 263.5 ± 62.0 | 0.037 | 256.9 ± 79.7 | 263.5 ± 62.0 | 0.856 |
Aortic cross-clamping time, mean ± SD, min | 79.9 ± 24.8 | 88.7 ± 20.7 | <0.001 | 80.3 ± 24.6 | 88.7 ± 20.7 | 0.007 |
Cardiopulmonary bypass time, mean ± SD, min | 132.7 ± 44.5 | 144.0 ± 29.9 | 0.026 | 132.9 ± 44.9 | 144.0 ± 29.9 | 0.049 |
Repeated cardioplegia, n (%) | 11 (3.1) | 0 (0.0) | 0.224 | 3(4.3) | 0 (0.0) | 0.080 |
Valve type, n (%) | ||||||
Biological | 163 (45.8) | 60 (85.7) | <0.001 | 24 (34.3) | 60 (85.7) | <0.001 |
Mechanical | 193 (54.2) | 10 (14.3) | <0.001 | 46 (65.7) | 10 (14.3) | <0.001 |
Size of aortic valve prosthesis, n (%) | ||||||
19 mm | 1 (0.3) | 0 (0.0) | 0.657 | 0 (0.0) | 0 (0.0) | ND |
21 mm | 57 (16.0) | 4 (5.6) | 0.025 | 7 (10.0) | 4 (5.7) | 0.346 |
23 mm | 154 (43.3) | 34 (47.2) | 0.549 | 36 (51.4) | 33 (47.1) | 0.612 |
25 mm | 111 (31.2) | 30 (41.7) | 0.095 | 19 (27.1) | 29 (41.4) | 0.075 |
27 mm | 31 (8.7) | 4 (5.6) | 0.404 | 8 (11.4) | 4 (5.7) | 0.227 |
29 mm | 2 (0.6) | 0 (0.0) | 0.530 | 0 (0.0) | 0 (0.0) | ND |
Indicator | Overall Cohort | Propensity Score Matched Cohort | ||||
---|---|---|---|---|---|---|
Full Sternotomy n = 356 | Mini-Sternotomy n = 70 | p | Full Sternotomy n = 70 | Mini-Sternotomy n = 70 | p | |
Ventilation time, mean ± SD, h | 11.7 ± 17.0 | 9.7 ± 1.7 | 0.213 | 11.7 ± 1.4 | 9.7 ± 1.7 | <0.001 |
Blood loss ≥1000 mL/24 h, n (%) | 27 (7.6) | 1 (1.4) | 0.069 | 2 (2.9) | 1 (1.4) | 0.559 |
24-h chest tube drainage, mean± SD, mL | 411.9 ± 294.6 | 256.2 ± 28.6 | <0.001 | 407.6 ± 40.37 | 256.2 ± 28.6 | <0.001 |
Coagulopathy correction, n (%) | 87 (24.4) | 0 (0.0) | <0.001 | 14 (20.0) | 0 (0.0) | <0.001 |
Blood product transfusion, n (%) Packed red blood cells Platelet concentrates Fresh frozen plasma | 78 (21.9) 7 (2.0) 29 (8.1) | 12 (17.1) 4 (5.7) 1 (1.4) | 0.265 0.096 0.041 | 15 (21.4) 1 (1.4) 5 (7.1) | 12 (17.1) 4 (5.7) 1 (1.4) | 0.520 0.172 0.095 |
ICU stay, mean ± SD, h | 83.8 ± 124.8 | 68.97 ± 6.3 | 0.305 | 88.41 ± 20.62 | 68.97 ± 6.3 | 0.319 |
Hospital stay, mean ± SD, days | 21.9 ± 18.2 | 18.3 ± 1.9 | 0.109 | 21.9 ± 1.9 | 18.3 ± 1.9 | 0.012 |
Hospital stay after surgery, mean ± SD, days | 17.6 ± 16.9 | 13.06 ± 1.0 | 0.025 | 15.2 ± 1.5 | 13.06 ± 1.0 | 0.113 |
30-day mortality, n (%) | 13 (3.7) | 1 (1.4) | 0.022 | 0(0.0) | 1 (1.4) | 0.316 |
Resternotomy, n (%) | 21 (6) | 0 (0.0) | <0.001 | 2(2.9) | 1 (1.4) | 0.559 |
Endocarditis, n (%) | 18 (5.1) | 1 (1.4) | 0.384 | 5(7.1) | 1 (1.4) | 0.095 |
Wound infection, n (%) | 19 (5.3) | 2 (2.9) | 0.645 | 2(2.9) | 2 (2.9) | 1,000 |
Cardiac tamponade, n (%) | 15 (4.2) | 1 (1.4) | 0.489 | 1(1.4) | 1 (1.4) | 1.000 |
Acute renal failure, n (%) | 28 (7.9) | 2 (2.9) | 0.067 | 1(1.4) | 2 (2.9) | 0.559 |
Other actions, n (%) ECMO IABP | 2 (0.6) 16 (4.5) | 1 (1.4) 0 (0.0) | 0.108 0.054 | 0 (0.0) 0 (0.0) | 1 (1.4) 0 (0.0) | 0.428 |
Cardiac rhythm at discharge New atrial fibrillation, n (%) New pacemaker, n (%) | 18 (5.1) 12 (3.4) | 3 (4.3) 3 (4.3) | 0.071 0.902 | 3 (4.3) 4 (5.71) | 3 (4.3) 3 (4.3) | 1.000 0.698 |
Number of patients treated with: Catecholamine, n (%) Morphine, n (%) | 21 (30.0) 350 (98.31) | 4 (5.71) 63 (90.0) | <0.001 0.042 | 21(30.0) 69 (98.57) | 4 (5.71) 63 (90.0) | <0.001 0.029 |
Morphine dose, mean ± SD, mg | 18.56 ± 17.08 | 8.33 ± 3.58 | <0.001 | 18.56 ± 17.08 | 8.33 ± 3.58 | <0.001 |
LVEF% at discharge, n (%) <30% 30%–49% ≥50% | 7 (2.1) 49 (14.7) 278 (83.2) | 0 (0.0) 12 (17.4) 57 (82.6) | 0.732 0.427 0.428 | 0 (0.0) 13 (18.6) 57 (81.4) | 0 (0.0) 12 (17.4) 57 (82.6) | ND 0.856 0.856 |
Variables | Relative Risk (RR) | 95% CI | p Value |
---|---|---|---|
Preop hypertension (no vs. yes) | 1.717 | 0.320–9.209 | 0.528 |
Preop LVEF (30–49% vs. >50%) | 0.156 | 0.031–0.774 | 0.023 |
Aortotomy (transverse vs. J-shaped) | 0.761 | 0.124–4.668 | 0.768 |
Type of cardioplegia | |||
(coronary ostium vs. both) | 1.326 | 0.156–11.301 | 0.796 |
(retrograde vs. both) | 0.140 | 0.006–3.494 | 0.231 |
Aortic valve type (biological vs. mechanical) | 1.059 | 0.154–7.303 | 0.953 |
Coagulopathy correction (no vs. yes) | 7.412 | 1.046–52.508 | 0.045 |
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Aliahmed, H.M.A.; Karalius, R.; Valaika, A.; Grebelis, A.; Semėnienė, P.; Čypienė, R. Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy). Medicina 2018, 54, 26. https://doi.org/10.3390/medicina54020026
Aliahmed HMA, Karalius R, Valaika A, Grebelis A, Semėnienė P, Čypienė R. Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy). Medicina. 2018; 54(2):26. https://doi.org/10.3390/medicina54020026
Chicago/Turabian StyleAliahmed, Hammad M. A., Rimantas Karalius, Arūnas Valaika, Arimantas Grebelis, Palmyra Semėnienė, and Rasa Čypienė. 2018. "Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy)" Medicina 54, no. 2: 26. https://doi.org/10.3390/medicina54020026