SPC365

Technique of Ministernotomy in Aortic Valve Replacement. Does intraoperative conversion to full sternotomy increase morbidity and mortality? A single center analysis.

Session: Prémio Manuel Machado Macedo em Cirurgia Cardíaca
Speaker: Hagen Kahlbau

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 26. Cardiovascular Surgery
Subtheme: 26.11 Cardiovascular Surgery - Other
Session Type: Prémios, Registos e Sessões Especiais
FP Number: ---
Authors: Hagen Kahlbau; Pedro Félix; Valdemar Marques Gomes; Luís Miranda; Pedro Coelho

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Aortic valve replacement (AVR) through ministernotomy (MS) is considered a safe and reproducible surgical approach to treat aortic valve diseases. The objective of this study is to analyze the impact of intraoperative conversion to full sternotomy in our case series.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Material and Methods</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Patients are selected to different surgical teams within our department. Two senior surgeons perform routinely MS in AVR and train residents and newly specialists. Patients with significant comorbidities such as previous cardiac surgery, dilated left ventricle, severe structural or thoracic alterations, hemodynamic instability or other cardiac diseases with surgical indication are excluded. If a complication occurs during surgery that jeopardizes the procedures&rsquo; safety, conversion to full sternotomy should be performed.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">In our series a total of 80 patients were operated through a MS. Pre-operative characteristics are described in the table 1.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Intra- and post-operative characteristics are shown in table 2 and 3. A total of 5 patients (6,25%) needed conversion to full sternotomy. The reasons for conversions are stated in table 4. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Mean age of the converted group was significantly higher (mean age 74 years, CI: 62;87). There were no differences in the preoperative characteristics. Mean procedure time was 180 minutes, cardiopulmonary bypass time was 83 minutes and aortic cross clamp time 63 minutes. Mean ventilation time was significantly increased (mean 12,8 h), however with no prolonged ventilation (&gt; 24 hours). Total hemorrhage was significantly increased (mean of 1284 ml). All patients needed blood transfusions and / or fresh frozen plasma units.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Postoperatively there was no occurrence of renal complications, new onset of atrial fibrillation or wound complications. Mean ICU and hospital stay was identical in the conversion group.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Discussion</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">MS can be safely performed without increasing the risk of death or other major complications. In our series 5 patients needed to be converted (6,25%), which is within the range described in the literature. Significant differences were longer ventilation time and significantly increased total hemorrhage with need of blood transfusions and fresh frozen plasma units in all patients. Hospitalization time or major postoperative complications were not increased. Since necessity of conversion has not changed the clinical outcome, we conclude that MS is a strong alternative to full sternotomy.</span></span></span></span></p>