The aim of this study was to report the first results of our multidisciplinary minimally invasive program to treat patients who require aortic valve replacement (AVR), which involves: 1) reduced chest incision (through upper ministernotomy or right anterior minithoracotomy), 2) sutureless or rapid deployment AVR, 3) minimally invasive extracorporeal circulation (MiECC) system and 4) ultra fast-track (UFT) anaesthesia.
Data from 167 consecutive patients undergoing primary isolated aortic valve replacement through minimally invasive approaches (MIAVR) between October 2016 and April 2018 were prospectively collected. The mean age of the study population was 74 ± 9 years, and the average EuroSCORE II was 2.1 ± 1.2.
MIAVR was performed using sutureless or rapid deployment valves in 76 (45.5%) patients, MiECC system in 63 (37.7%), and UFT management in 67 (40.1%). Overall in-hospital mortality was 0.6% (n = 1). The rate of postoperative stroke and atrioventricular block requiring pacemaker implantation was 1.2% (n = 2) and 3.6% (n = 6), respectively. MiECC system was associated with reduced postoperative bleeding (requiring chest re-opening) compared with conventional cardio-pulmonary bypass circuits (0% vs. 5.8%, p = 0.05). The mean intensive care unit stay was 25 hours in UFT patients and 52.2 hours in no-UFT patients (p = 0.04). Hospital stay was similar between groups (UFT 6.9 days, no-UFT 13.9 days, p = 0.2).
Our UFT mini AVR program is a multidisciplinary minimally approach that involves the latest best technologies and techniques for AVR. We believe it may considerably increase patient's comfort being associated with faster recovery and excellent hospital outcomes.
1SOD Cardiochirurgia, Ospedali Riuniti, Università Politecnica delle Marche Ancona
2SOD Anestesia e Rianimazione Cardiochirurgica, Ospedali Riuntiti di Ancona Ancona
3Dipartimento di Scienze Cardiovascolari, unità di Perfusione Cardiovascolare, Ospedali Riuniti di Ancona Ancona