Aortic valve replacement through J-ministernotomy in patients over 65 years old

Authors: Niyazov S.S., Kovalyov A.I., Kambarov S.Yu.

Company: 1 N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russian Federation
2 A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation

For correspondence:  Sign in or register.

Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2023-17-4-514-524

For citation: Niyazov S.S., Kovalyov A.I., Kambarov S.Yu. Aortic valve replacement through J-ministernotomy in patients over 65 years old. Creative Cardiology. 2023; 17 (4): 514–24 (in Russ.). DOI: 10.24022/1997-3187-2023-17-4-514-524

Received / Accepted:  24.10.2023 / 28.11.2023

Keywords: aortic valve replacement minimally invasive access J-shaped ministernotomy elderly age

Download
Full text:  

 

Abstract

Objective. Compare the immediate results of aortic valve replacement (AVR) in patients over 65 years old through J-shaped ministernotomy and full median sternotomy.

Material and methods. A cohort clinical study was conducted to evaluate the outcomes of surgical intervention in 73 patients over 65 years old who underwent isolated AVR. In the first group, there were 42 (57.5%) patients who had AVR performed through a full sternotomy, with a sutureless prosthesis implanted in 18 cases. The second group included 31 (42.5%) patients operated through a J-shaped ministernotomy, with a sutureless prosthesis used in 11 patients. The analysis included intraoperative results, the volume of perioperative blood loss and transfusions, duration of mechanical ventilation and stay in the ICU, frequency of complications, postoperative bed-days, and 30-day mortality.

Results. In the second group, there was an increase in the duration of cardiopulmonary bypass (CPB) (p<0.001), aortic cross-clamp time (p=0.012), and length of surgery (p=0.009), with a lower volume of intraoperative blood loss (p=0.043) and frequency of transfusions (p=0.021) compared to the first group. The implantation of a sutureless prosthesis through a J-shaped ministernotomy was characterized by statistically significantly shorter CPB time, aortic cross-clamp time, and duration of surgery, compared to the use of suture fixation prostheses (p<0.001). In the postoperative period, the duration of mechanical ventilation (p=0.012), volume of blood loss (p=0.037), and frequency of blood component transfusions (p=0.047) were statistically significantly lower in the second group of patients. No statistically significant differences were found in the frequency of complications, time spent in the ICU, postoperative bed-days, and mortality.

Conclusion. In our study, the use of J-shaped ministernotomy for AVR in elderly patients was characterized by a reduction in perioperative blood loss and transfusions of blood components, as well as a decrease in the duration of mechanical ventilation compared to full sternotomy. However, the J-shaped ministernotomy was associated with an increase in cardiopulmonary bypass time and aortic cross-clamping time. According to our results, this issue can be mitigated through the use of sutureless prostheses.

References

  1. Belov Yu.V., Salagaev G.I., Lysenko A.V., Lednev P.V. Minimally invasive aortic valve replacement. Pirogov Russian Journal of Surgery (Khirurgiya. Zhurnal imeni N.I. Pirogova). 2017; 12: 66–9. DOI: 10.17116/hirurgia20171266-69 (in Russ.).
  2. Rosengart T.K., Feldman T., Borger M.A., Vassiliades T.A., Jr., Gillinov A.M., Hoercher K.J. et al. Percutaneous and minimally invasive valve procedures. Circulation. 2008; 117 (13): 1750–67. DOI: 10.1161/CIRCULATIONAHA.107.188525
  3. Komarov R.N., Ognev O.O., Ismailbaev A.M., Chernyavsky S.V., Dzyundzia A.N., Lenkovets M.V. State-of-the-art surgical approaches in minimally invasive aortic valve surgery. Circulation Pathology and Cardiac Surgery (Patologiya Krovoobrashcheniya i Kardiokhirurgiya). 2022; 26 (3): 31–40. DOI: 10.21688/1681-3472-2022-3-31-40 (in Russ.).
  4. Vahanian A., Beyersdorf F., Praz F., Milojevic M., Baldus S., Bauersachs J. et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: developed by the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur. Heart J. 2022; 43 (7): 561–632. DOI: 10.1093/eurheartj/ehab395
  5. The EuroSCORE Risk Calculator. Royal Papworth Hospital. https://www.euroscore.org/ (accessed September 21, 2023).
  6. Cohn L.H., Adams D.H., Couper G.S., Bichell D.P., Rosborough D.M., Sears S.P., Aranki S.F. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann. Surg. 1997; 226 (4): 421– 6; discussion 427–8. DOI: 10.1097/00000658-199710000-00003
  7. Torky M.A., Arafat A.A., Fawzy H.F., Taha M.A., Wahby E.A., Herijgers P. J-ministernotomy for aortic valve replacement: a retrospective cohort study. Cardiothorac. Surg. 2021; 29 (16). DOI: 10.1186/s43057-021-00050-7
  8. Charchian É.R., Breshenkov D.G., Belov Yu.V. Minimally invasive approach in thoracic aortic surgery: a single center experience. Kardiologiya i Serdechno-Sosudistaya Khirurgiya (Cardiology and Cardiovascular Surgery). 2019; 12 (6): 522–35. DOI: 10.17116/kardio201912061522 (in Russ.).
  9. Rayner T.A., Harrison S., Rival P., Mahoney D.E., Caputo M., Angelini G.D. et al. Minimally invasive versus conventional surgery of the ascending aorta and root: a systematic review and meta-analysis. Eur. J. Cardiothorac. Surg. 2020; 57 (1): 8–17. DOI: 10.1093/ejcts/ezz177
  10. Shehada S.E., Elhmidi Y., Mourad F., Wendt D., El Gabry M., Benedik J. et al. Minimal access versus conventional aortic valve replacement: a meta-analysis of propensity-matched studies. Interact. Cardiovasc. Thorac. Surg. 2017; 25 (4): 624–32. DOI: 10.1093/icvts/ivx212
  11. Ghoreishi M., Thourani V.H., Badhwar V., Massad M., Svensson L., Taylor B.S. Invasive aortic valve replacement: trends and outcomes from the society of thoracic surgeons database. Ann. Thorac. Surg. 2021; 111 (4): 1216–23. DOI: 10.1016/j.athoracsur.2020.06.039
  12. Al-Sarraf N., Thalib L., Hughes A., Houlihan M., Tolan M., Young V., McGovern E. Cross-clamp time is an independent predictor of mortality and morbidity in low- and high-risk cardiac patients. Int. J. Surg. 2011; 9 (1): 104–9. DOI: 10.1016/j.ijsu.2010.10.007
  13. Ranucci M., Frigiola A., Menicanti L., Castelvecchio S., de Vincentiis C., Pistuddi V. Aortic cross-clamp time, new prostheses, and outcome in aortic valve replacement. J. Heart Valve Dis. 2012; 21 (6): 732–9.
  14. Nešpor D., Ondrášek J., Štěrba J., Kára T., Němec P. Our experience with surgical minimally invasive aortic valve replacement. Cor. Vasa. 2018; 60 (6): 589–96. DOI: 10.1016/j.crvasa.2017.12.007

About Authors

  • Saidislom S. Niyazov, Junior Researcher, Cardiovascular Surgeon; ORCID
  • Aleksey I. Kovalyov, Cand. Med. Sci., Cardiovascular Surgeon, Head of Department of Cardiac Surgery # 2 of N.V. Sklifosovsky RIEM, Associate Professor of the Department of X-ray Endovascular and Vascular Surgery of A.I. Yevdokimov MSUMD; ORCID
  • Sergey Yu. Kambarov, Dr. Med. Sci., Chief Researcher, Cardiovascular Surgeon; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery