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Transesophageal echocardiography-guided device occlusion of ventricular septal defects: a propensity score matching analysis of left anterior mini-thoracotomy vs. lower partial median sternotomy.

ABSTRACT:

SUBMITTER: Lu XF

PROVIDER: S-EPMC8631375 | biostudies-literature | 2021 Jun

REPOSITORIES: biostudies-literature

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Transesophageal echocardiography-guided device occlusion of ventricular septal defects: a propensity score matching analysis of left anterior mini-thoracotomy vs. lower partial median sternotomy.

Lu Xiao-Feng XF Wei Shi-Lin SL Li Na-Na NN Zhang Peng-Bin PB Gao Bing-Ren BR Liu De-Bin DB

Chinese medical journal 20210615 22

PMID: 34845996

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Project description:BackgroundRecently adopted mini-thoracotomy approach for surgical aortic valve replacement has shown benefits such as reduced pain and shorter recovery, compared to more conventional mini-sternotomy access. However, whether limited exposure of the heart and ascending aorta resulting from an incision in the second intercostal space may lead to increased intraoperative cerebral embolization and more prominent postoperative neurologic decline, remains inconclusive. The aim of our study was to assess potential neurological complications after two different minimal invasive surgical techniques for aortic valve replacement by measuring cerebral microembolic signal during surgery and by follow-up cognitive evaluation.MethodsTrans-cranial Doppler was used for microembolic signal detection during aortic valve replacement performed via mini-sternotomy and mini-thoracotomy. Patients were evaluated using Addenbrooke's Cognitive Examination Revised Test before and 30 days after surgical procedure.ResultsA total of 60 patients were recruited in the study. In 52 patients, transcranial Doppler was feasible. Of those, 25 underwent mini-sternotomy and 27 had mini-thoracotomy. There were no differences between groups with respect to sex, NYHA class distribution, Euroscore II or aortic valve area. Patients in mini-sternotomy group were younger (60.8 ± 14.4 vs.72 ± 5.84, p = 0.003), heavier (85.2 ± 12.4 vs.72.5 ± 12.9, p = 0.002) and had higher body surface area (1.98 ± 0.167 vs. 1.83 ± 0.178, p = 0.006). Surgery duration was longer in mini-sternotomy group compared to mini-thoracotomy (158 ± 24 vs. 134 ± 30 min, p < 0.001, respectively). There were no differences between groups in microembolic load, length of ICU or total hospital stay. Total microembolic signals count was correlated with cardiopulmonary bypass duration (5.64, 95%CI 0.677-10.60, p = 0.027). Addenbrooke's Cognitive Examination Revised Test score decreased equivalently in both groups (p = 0.630) (MS: 85.2 ± 9.6 vs. 82.9 ± 11.4, p = 0.012; MT: 85.2 ± 9.6 vs. 81.3 ± 8.8, p = 0.001).ConclusionThere is no difference in microembolic load between the groups. Total intraoperative microembolic signals count was associated with cardiopulmonary bypass duration. Age, but not micorembolic signals load, was associated with postoperative neurologic decline. TRIAL REGISTRY NUMBER: clinicaltrials.gov , NCT02697786 14.

Dataset Information

Transesophageal echocardiography-guided device occlusion of ventricular septal defects: a propensity score matching analysis of left anterior mini-thoracotomy vs. lower partial median sternotomy.

Publications

Transesophageal echocardiography-guided device occlusion of ventricular septal defects: a propensity score matching analysis of left anterior mini-thoracotomy vs. lower partial median sternotomy.

Similar Datasets

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