Direct aorta implantation of microaxial blood pump via right anterior thoracotomy.
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ABSTRACT:
SUBMITTER: Takagi K
PROVIDER: S-EPMC10268493 | biostudies-literature | 2023 Jun
REPOSITORIES: biostudies-literature
Publications
Direct aorta implantation of microaxial blood pump via right anterior thoracotomy.
Takagi Kazuyoshi K Saku Kosuke K Kono Takanori T Zaima Yasuyuki Y Matsushima Yoshihisa Y Homma Takehiro T Shibata Tatsuhiro T Otsuka Maki M Yokomizo Michiko M Ohshita Kensuke K Fukumoto Yoshihiro Y Tayama Eiki E
JTCVS techniques 20230420
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Project description:BackgroundAortic regurgitation with dilated annulus presents a technical challenge for conventional transcatheter aortic valve implantation (TAVI) procedures.Case presentationWe report a case of an 84-year-old frail patient with a history of breathlessness found to have severe aortic regurgitation and moderately impaired left ventricular systolic function. The patient underwent a successful TAVI procedure using the XL-Myval 32 mm transcatheter heart valve (THV) via an anterior right mini-thoracotomy with a direct aortic approach. The patient recovered well post-operatively with good hemodynamic resolution.ConclusionsThis first in human case highlights the efficacy and potential of applying innovative approaches, such as the new sizes of Myval THV and direct aortic access via anterior right mini thoracotomy, in addressing challenging anatomical variations in TAVI procedures with good outcome.
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Project description:IntroductionPropensity score analysis of midterm outcomes after isolated aortic valve replacement through right anterior mini-thoracotomy and partial upper sternotomy could provide information about the most beneficial minimally invasive technique for the patient based on the preoperative risk factors.MethodsBetween March 2015 and February 2021, 694 minimally invasive isolated aortic valve surgeries were performed at our institution. Among these, 441 right anterior mini-thoracotomies and 253 partial upper sternotomies were performed. A propensity score analysis was performed in 202 matched pairs.ResultsCardiopulmonary bypass time and cross-clamp time were significantly shorter in the right anterior mini-thoracotomy group than in the partial upper sternotomy group (p = 0.001 and p < 0.001, respectively). Time to first mobilization and hospital stay were significantly shorter in the right anterior mini-thoracotomy group than in the partial upper sternotomy group (p = 0.005, p = 0.001, respectively). A significantly lower incidence of revision surgery was noted in the right anterior mini-thoracotomy group than in the partial upper sternotomy group (p = 0.046). No significant differences in 30-day mortality (p = 1.000) and 1-year mortality (p = 0.543) were noted. Kaplan-Meier survival estimates were 96.3% in the right anterior mini-thoracotomy group and 92.7% in the partial upper sternotomy group after 4 years (log rank 0.169), respectively.ConclusionsDespite the technical challenges, right anterior mini-thoracotomy can be chosen as first-line strategy for isolated aortic valve replacement. For patients unsuitable for this technique, the partial upper sternotomy remains a safe method that can be performed by a wide range of surgeons.
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Project description:BackgroundMinimally invasive procedures are increasingly implemented in aortic valve replacement (AVR) surgeries to minimize surgical trauma and achieve early patient recovery. We aimed to compare between short- and mid-term outcomes for isolated AVR using the representative minimally invasive approaches of right anterior mini-thoracotomy (RAMT) and partial upper sternotomy [J-sternotomy (JS)].MethodsPatients (n=832) who had undergone surgical AVR between March 2009 and September 2022 were included. We retrospectively examined and compared data from these two minimally invasive approaches, and performed propensity score matching to account for differences in patient baseline characteristics. Early outcomes and late mortality were compared between the matched groups.ResultsAfter applying exclusion criteria, the study comprised 315 patients who underwent RAMT and 92 who underwent JS. Patients who underwent JS had more comorbidities, compared with those who underwent RAMT. Propensity score matching of 16 variables yielded similar groups for comparison (n=90). Thirty-day mortality was similar between the two groups (0% vs. 1%, respectively; P>0.99). In the RAMT group, the rate of on-table extubation was significantly higher (P<0.001), whereas the blood transfusion rate was lower and length of stay was shorter, compared with the JS group. The 5-year survival rate was higher in the RAMT group than in the JS group (95.0% vs. 85.6%, respectively; P=0.03).ConclusionsAVR via RAMT was associated with improved early clinical outcomes, shorter length of stay, and increased survival, compared with JS. Despite the technical challenges associated with RAMT, this procedure can be considered a primary strategy for isolated AVR.
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