S. A. Hirji1, F. Ramirez Del Val1, A. A. Kolkailah1, J. Lee1, S. F. Aranki1, P. S. Shekar1, T. Kaneko1 1Brigham And Women’s Hospital,Division Of Cardiac Surgery, Department Of Surgery,Boston, MA, USA
Introduction: Compared to aortic valve replacement (AVR) via full sternotomy (fAVR), minimally invasive AVR (mAVR) has been associated with improved results. The likely expansion of Transcatheter AVR (TAVR) to low-risk patients demands contemporary outcomes for fAVR versus mAVR in this population. We compared the postoperative outcomes and mid-term survival of these two approaches in a large cohort of low-risk patients.
Methods: Between 2002 and 2015, 2,095 low-risk patients (Society of Thoracic Surgeons Predicted Risk of Mortality score (STS PROM ≤ 4)) underwent elective isolated AVR, including 1029 (49%) mAVR and 1066 (51%) fAVR. Median follow-up was 5.3 years.
Results: Compared to mAVR patients, fAVR patients had a significantly higher burden of comorbidities such as diabetes (23% vs 11%), stroke (4% vs 2%), congestive heart failure (CHF) (41% vs 24%) and STS-PROM (1.91±0.95 vs 1.81±0.99), all p ≤ 0.05. However, both groups were similar in terms of gender, age, and preoperative creatinine, p > 0.05. Notably, operative mortality (1.1% vs.1.3%), stroke (3% vs. 2%), and re-operation rates for bleeding (1% vs. 2%) were similar between fAVR and mAVR, respectively, all p > 0.05. Median intensive care unit (ICU) stay (31 hours (interquartile range (IQR) 23,61) vs 42 hours (IQR 24, 68); p=0.075) and hospital length of stay (LOS) (6 days (IQR 5,7) vs 6 days (IQR 5,8); p ≤ 0.001) were significantly shorter among mAVR patients. Adjusted survival analysis identified age (Hazard Ratio (HR) 1.05), chronic kidney disease (HR 4.96), prior sternotomy (HR 1.56), and CHF (HR 2.00) as significant predictors of decreased survival (all p ≤ 0.030), while type of intervention, mAVR vs fAVR, was non-contributory (HR 1.58; p=0.49).
Conclusion: In low-risk patients, mAVR results in shorter ICU and hospital LOS, while maintaining similar rate of mortality, stroke, reoperation for bleeding and mid-term survival, compared to fAVR. Therefore, mAVR should stand as a benchmark against TAVR in the low-risk patients.
