Aortic valve replacement through minithoracotomy. Results from the Peruvian experience

Autores/as

  • Josías C. Ríos-Ortega Departamento de Cirugía Cardiovascular, Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú. https://orcid.org/0000-0002-4396-7954
  • Josué Sisniegas-Razón Departamento de Cirugía Cardiovascular, Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú. https://orcid.org/0000-0001-5413-6032
  • Roger Conde-Moncada Departamento de Cirugía Cardiovascular, Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú. https://orcid.org/0000-0002-6972-159X
  • Yemmy Pérez-Valverde Departamento de Cirugía Cardiovascular, Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú. https://orcid.org/0000-0001-7942-2895
  • Julio Morón-Castro Departamento de Cirugía Cardiovascular, Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú. https://orcid.org/0000-0002-7964-7311

DOI:

https://doi.org/10.47487/apcyccv.v3i2.219

Palabras clave:

Aortic valve, Thoracotomy, Cardiac Surgery, Peru

Resumen

Objectives. To assess mortality, major valve-related events (MAVRE), and other complications in the perioperative period and follow up in patients with aortic valve replacement (AVR) through minithoracotomy (MT). Methods. We retrospectively analyzed patients aged <80 who underwent AVR through MT between January 2017 and December 2021 in a national reference center in Lima, Peru. Patients undergoing other surgical approaches (mini-sternotomy, etc.), other concomitant cardiac procedures, redo, and emergency surgeries were excluded. We measured the variables (MAVRE, mortality, and other clinical variables) at 30 days and a mean follow-up of 12 months. Results. Fifty-four patients were studied, the median age was 69.5 years, and 65% were women. Aortic valve (AV) stenosis was the main indication for surgery (65%), and bicuspid AV represented 55.6% of cases. At 30-days, MAVRE occurred in two patients (3.7%), with no in-hospital mortality. One patient had an intraoperative ischemic stroke, and one required a permanent pacemaker. No patient underwent reoperation due to prosthesis dysfunction or endocarditis. In a mean follow-up of one year, MAVRE occurrence did not show variations with the perioperative period, most patients remained in NYHA I (90.7%) or II (7.4%) compared to the preoperative period (p<0.001). Conclusions. AV replacement through MT is a safe procedure in our center for patients under 80 years.

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Iung B, Delgado V, Rosenhek R, Price S, Prendergast B, Wendler O, et al. Contemporary presentation and management of valvular heart disease: The EURObservational Research Programme Valvular Heart Disease II Survey. Circulation. 2019;140(14):1156-1169. doi: 10.1161/CIRCULATIONAHA.119.041080.

Yadgir S, Johnson CO, Aboyans V, Adebayo OM, Adedoyin RA, Afarideh M, et al. Global, regional, and national burden of

calcific aortic valve and degenerative mitral valve diseases, 1990-2017. Circulation. 2020;141(21):1670-1680. doi: 10.1161/CIRCULATIONAHA.119.043391.

Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632. doi: 10.1093/eurheartj/ehab395.

Losanoff JE, Richman BW, Jones JW. Disruption and infection of median sternotomy: a comprehensive review. Eur J Cardiothorac Surg. 2002;21(5):831-9. doi: 10.1016/s1010-7940(02)00124-0.

Huang AP, Sakata RK. Pain after sternotomy - review. Braz J Anesthesiol. 2016;66(4):395-401. doi: 10.1016/j.bjane.2014.09.013.

King KM, McFetridge-Durdle J, LeBlanc P, Anzarut A, Tsuyuki RT. A Descriptive Examination of the Impact of Sternal Scar Formation in Women. Eur J Cardiovasc Nurs. 2009;8(2):112-118. doi: 10.1016/j.ejcnurse.2008.08.001

İyigün T, Kaya M, Gülbeyaz SÖ, Fıstıkçı N, Uyanık G, Yılmaz B, et al. Patient body image, self-esteem, and cosmetic results of minimally invasive robotic cardiac surgery. Int J Surg. 2017;39:88-94. doi: 10.1016/j.ijsu.2017.01.105.

Svensson LG. Minimal-access “J” or “j” sternotomy for valvular, aortic, and coronary operations or reoperations. Ann Thorac Surg. 1997;64(5):1501-3. doi: 10.1016/S0003-4975(97)00927-2.

Moreno-Cabral RJ. Mini-T sternotomy for cardiac operations. J Thorac Cardiovasc Surg. 1997;113(4):810-1. doi: 10.1016/S0022-5223(97)70252-6.

Akins CW, Miller DC, Turina MI, Kouchoukos NT, Blackstone EH, Grunkemeier GL, et al. Guidelines for reporting mortality and morbidity after cardiac valve interventions. J Thorac Cardiovasc Surg. 2008;135(4):732-8. doi: 10.1016/j.jtcvs.2007.12.002.

Bevan GH, Zidar DA, Josephson RA, Al-Kindi SG. Mortality Due to Aortic Stenosis in the United States, 2008-2017. JAMA. 2019;321(22):2236-2238. doi: 10.1001/jama.2019.6292.

Powell R, Pelletier MP, Chu MWA, Bouchard D, Melvin KN, Adams C. The Perceval Sutureless Aortic Valve: Review of Outcomes, Complications, and Future Direction. Innovations (Phila). 2017;12(3):155-173. doi: 10.1097/IMI.0000000000000372.

Glauber M, Ferrarini M, Miceli A. Minimally invasive aortic valve surgery: state of the art and future directions. Ann Cardiothorac Surg. 2015;4(1):26-32. doi: 10.3978/j.issn.2225-319X.2015.01.01.

Phan K, Xie A, Di Eusanio M, Yan TD. A meta-analysis of minimally invasive versus conventional sternotomy for aortic valve replacement. Ann Thorac Surg. 2014;98(4):1499-511. doi: 10.1016/j.athoracsur.2014.05.060.

Brown ML, McKellar SH, Sundt TM, Schaff HV. Ministernotomy versus conventional sternotomy for aortic valve replacement: a systematic review and meta-analysis. J Thorac Cardiovasc Surg. 2009;137(3):670-679.e5. doi: 10.1016/j.jtcvs.2008.08.010.

Ariyaratnam P, Loubani M, Griffin SC. Minimally invasive aortic valve replacement: Comparison of long-term outcomes. Asian Cardiovasc Thorac Ann. 2015;23(7):814-21. doi: 10.1177/0218492315587606.

Chang C, Raza S, Altarabsheh SE, Delozier S, Sharma UM, Zia A, et al. Minimally Invasive Approaches to Surgical Aortic Valve Replacement: A Meta-Analysis. Ann Thorac Surg. 2018;106(6):1881-1889. doi: 10.1016/j.athoracsur.2018.07.018.

Yousuf Salmasi M, Hamilton H, Rahman I, Chien L, Rival P, Benedetto U, et al, Vohra HA. Mini-sternotomy vs right anterior thoracotomy for aortic valve replacement. J Card Surg. 2020;35(7):1570-1582. doi: 10.1111/jocs.14607.

Fortunato J, Jeronimo A, Sesca J, Paludo R, Paz M, Paludo L, et al. Troca valvar aórtica minimamente invasiva: uma alternativa à técnica convencional. Braz J Cardiovasc Surg. 2012;27(4):570-582. doi: 10.5935/1678-9741.20120099.

Benetti F, Rizzardi JL, Concetti C, Bergese M, Zappetti A. Minimally aortic valve surgery avoiding sternotomy. Eur J Cardiothorac Surg. 1999;16 Suppl 2:S84-5.

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Publicado

30-06-2022

Cómo citar

1.
Ríos-Ortega JC, Sisniegas-Razón J, Conde-Moncada R, Pérez-Valverde Y, Morón-Castro J. Aortic valve replacement through minithoracotomy. Results from the Peruvian experience. Arch Peru Cardiol Cir Cardiovasc [nternet]. 30 de junio de 2022 [citado 9 de agosto de 2022];3(2). isponible en: https://apcyccv.org.pe/index.php/apccc/article/view/219

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