A comparative study of minimally invasive aortic valve replacement with sutureless biological versus mechanical prostheses

Michał Bociański; Mateusz Puślecki; Anna Olasińska-Wiśniewska; Bartłomiej Perek; Sebastian Stefaniak; Piotr Buczkowski; Marek Jemielity

doi:10.5114/kitp.2023.129542

A comparative study of minimally invasive aortic valve replacement with sutureless biological versus mechanical prostheses

Kardiochir Torakochirurgia Pol. 2023 Jun;20(2):77-82. doi: 10.5114/kitp.2023.129542. Epub 2023 Jul 26.

Authors

Michał Bociański¹, Mateusz Puślecki^{1

2}, Anna Olasińska-Wiśniewska¹, Bartłomiej Perek¹, Sebastian Stefaniak¹, Piotr Buczkowski¹, Marek Jemielity¹

Affiliations

¹ Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland.
² Department of Medical Rescue, Chair of Rescue Medicine, Poznan University of Medical Sciences, Poznan, Poland.

Abstract

Introduction: The ministernotomy approach with sutureless aortic bioprosthesis may provide an attractive and safe option for aortic valve disease patients.

Aim: To assess the early and mid-term outcomes of minimally invasive aortic valve replacement (miniAVR) with sutureless vs. standard prostheses.

Material and methods: The study involved 76 consecutive patients (51 males and 25 females) with mean age of 63.2 years who were treated with miniAVR between 2015 and 2022. They were divided into 2 subgroups: group I (n = 40) subjects with sutureless bioprostheses and group II (n = 36) with standard prostheses implanted. Early and mid-term outcomes were evaluated. A probability of survival was estimated by means of the Kaplan-Meier method.

Results: No conversion to complete sternotomy was necessary. The median (minimum; maximum) aorta cross clamping and cardio-pulmonary bypass times were 49 (27; 84) and 70 (40; 188) minutes in group I whereas 69 (50; 103) and 95 (69; 170) minutes in group II, respectively (p < 0.001). In-hospital mortality was 5.0% (n = 2) and 2.8% (n = 1) in group I vs. II, respectively (ns). Permanent ICD implantation was performed in 8 (20.0%) in group I and in 3 (8.3%) subjects in group II. In the discharge echocardiography, the function of all prostheses was correct. Five-year probability of survival was much lower in group I (0.75 ±0.10) than in group II (0.94 ±0.04). No wound infection or sternum instability was noted.

Conclusions: Intraoperative advantages of miniAVR procedures for aortic valve patients with sutureless bioprostheses do not translate directly into improved early and middle-term outcomes.

Keywords: aortic valve disease; ministernotomy; outcomes; sutureless aortic prosthesis.

Copyright: © 2023 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).