Long-term Clinical Outcomes and Risk Predictors for Mortality After Minimally Invasive Aortic Valve Surgery.

A. Dokollari¹, F. Cabrucci², B. Bacchi³, S. Sicouri⁴, N. Ghoparde¹, B. Ramlawi⁵, M. Bonacchi^3
1St. Boniface Hospital, Winnipeg, Manitoba ²F.U. Clinical and Experimental Medicine, University of Florence, Firenze, Toscana ³F.U. Clinical and Experimental Medicine, University of Florence, Florence, Toscana ⁴Lankenau Institute for Medical Research, Wynnewood, Pennsylvania ⁵Lankenau Heart Institute, Wynnewood, Pennsylvania

Purpose: To analyze multicenter long-term clinical outcomes of minimally invasive aortic valve replacement (MI-AVR) in patients with aortic valve disease.

Methods: All consecutive 1,972 patients undergoing MI-AVR with either ministernotomy (n= 986) or right anterior minithoracotomy (RAM, n=986) between 1999 and 2019, were included. Primary outcomes were all-cause mortality and cardiac death.

Results: Preoperatively, mean age was 72.1 (±13.7) year-old, and mean STS-PROM was 0.38%.

Intraoperatively, mean operative time (min) was 213.97 (± 56.9), while 313 (15.9%) patients were converted to full sternotomy.

Postoperatively, 69 (3.5%) patients had prolonged mechanical ventilation (˃24 hours), 59 (3%) patients had re-exploration for bleeding, 10 (0.5%) patients had paravalvular leak (moderate/severe), 22 (1.1%) patients had non-fatal stroke, and 28 (1.4%) patients had non-fatal MI. Mean intensive care unit stay was 14.45 (± 10.15) hours, and mean hospital length of stay was 7 (±3.5) days.

Thirty-day all-cause mortality occurred in 39 (2%) patients while 30-day cardiac-death occurred in 23 (1.2%) patients.

Mean follow-up time was 10-years. At 20-year follow-up, all-cause death and cardiovascular death incidence were 1156 (60%) and 170 (8.8%) patients, respectively. Valve-related deaths occurred in 33 (1.7%) patients.

At follow-up, predictors for all-cause mortality included age ˃75-years, chronic kidney disease, mechanical ventilation ˃12 hours, RAM, and hospital length of stay ˃10 days.

Conclusion: MI-AVR is a safe, valid, and reproducible surgical procedure for patients with aortic valve disease.

Identify the source of the funding for this research project: No funding