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Respiratory System Function in Patients After Minimally Invasive Aortic Valve Replacement Surgery: A Case Control Study

Stoliński, Jarosław MD, PhD; Musiał, Robert MD; Plicner, Dariusz MD, PhD; Andres, Janusz MD, PhD

Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery: March/April 2017 - Volume 12 - Issue 2 - p 127–136
doi: 10.1097/IMI.0000000000000349
Original Articles

Objective: The aim of the study was to comparatively analyze respiratory system function after minimally invasive, through right minithoracotomy aortic valve replacement (RT-AVR) to conventional AVR.

Methods: Analysis of 201 patients scheduled for RT-AVR and 316 for AVR between January 2010 and November 2013. Complications of the respiratory system and pulmonary functional status are presented.

Results: Complications of the respiratory system occurred in 16.8% of AVR and 11.0% of RT-AVR patients (P = 0.067). The rate of pleural effusions, thoracenteses, pneumonias, or phrenic nerve dysfunctions was not significantly different between groups. Perioperative mortality was 1.9% in AVR and 1.0% in RT-AVR (P = 0.417). Mechanical ventilation time after surgery was 9.7 ± 5.9 hours for AVR and 7.2 ± 3.2 hours for RT-AVR patients (P < 0.001). Stroke (odds ratio [OR] = 13.4, P = 0.008), increased postoperative blood loss (OR = 9.6, P < 0.001), and chronic obstructive pulmonary disease (OR = 7.7, P < 0.001) were risk factors of prolonged mechanical lung ventilation. A week after surgery, the results of most pulmonary function tests were lower in the AVR than in the RT-AVR group (P < 0.001 was seen for forced expiratory volume in the first second, vital capacity, total lung capacity, maximum inspiratory pressure and maximum expiratory pressure, P = 0.377 was seen for residual volume).

Conclusions: Right anterior aortic valve replacement minithoracotomy surgery with single-lung ventilation did not result in increased rate of respiratory system complications. Spirometry examinations revealed that pulmonary functional status was more impaired after AVR in comparison with RT-AVR surgery.

From the Departments of *Cardiovascular Surgery and Transplantology and †Anaesthesiology and Intensive Therapy, Jagiellonian University of Cracow, John Paul II Hospital, Cracow, Poland.

Accepted for publication December 31, 2016.

Disclosure: The authors declare no conflicts of interest.

Address correspondence and reprint requests to Jarosław Stoliński, MD, PhD, Department of Cardiovascular Surgery and Transplantology, Jagiellonian University of Cracow, John Paul II Hospital, Prądnicka Street 80, 31-202 Cracow, Poland. E-mail: jstolinski@gmail.com.

©2017 by the International Society for Minimally Invasive Cardiothoracic Surgery