SPC365

Less-invasive aortic valve replacement: mid-term single-center results

Session: SESSÃO DE COMUNICAÇÕES ORAIS 21 - PRÉMIO MANUEL MACHADO MACEDO
Speaker: António Canotilho

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: António Canotilho; Helena Boavida; Irina Cristóvão; Carlos Branco; Pedro Correia; Gonçalo Coutinho; David Prieto
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000">INTRODUCTION: Less invasive aortic valve replacement has proved to be a safe approach for the treatment of aortic valve disease and is associated with reduced&nbsp;transfusion requirements, reduced intensive care and length of hospital stay, less pain and improved aesthetic appearance as quality of life including return to work.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000">OBJECTIVES: The aim of this study was to evaluate single center 4-year results of surgical aortic valve replacement by upper hemi-sternotomy approach.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000">METHODS: We reviewed 562 patients who underwent surgical aortic valve replacement by less invasive approach&ndash;upper hemi-sternotomy by 3<sup>rd</sup> and 4<sup>th </sup>right intercostal space from January 2021 to March 2024. Patients underwent aortic valve replacement by classic sternotomy were excluded. We analyzed the early and mid-term outcomes, in-hospital death&nbsp;and a subgroup survival analysis.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000">RESULTS:<span style="color:#222222"> Mean age of group was 67,8&plusmn;10,7years, 28,4% older than 75 years old(n=160)</span>, 65% were&nbsp;males<span style="color:#222222">. The preoperative data showed 59% of patients on NYHA III-IV, 1,9% had previous disability stroke, 34,7% with arterial hypertension;&nbsp;11,8% with severe aortic regurgitation, 77,6% with severe aortic stenosis, 33,8% with bicuspid aortic valve. &nbsp;Mean&nbsp; LVEF was 59,8&plusmn;7,9%, maximum/medium Aorta-LV Gradients 81,5&plusmn;21,6/50,5&plusmn;13,4mmHg and a mean Euroscore II 1,7&plusmn;2,6%. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="color:#222222">There were implanted 75,4% of biological/24% of mechanical prosthesis and 3 cases of aortic valve repair. Associated procedures:&nbsp;transannular aortic root enlargement in 2%, IV septum myectomy in 9,4%, left atrial appendage occlusion in 1,4% and aortic valve replacement associated to ascending Aorta replacement in 3,7%. The mean extra-corporal circulation time was 80,9&plusmn;23,2min and aortic cross-clamping time 50&plusmn;16,</span>6min. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000">About postoperative data, inotropic support &gt;12 hours was needed in 3% of patients, V-A ECMO in 0,2%,&nbsp;paroxysmal atrial fibrillation in 22,7%, 3<sup>rd</sup> degree AV block with need of permanent pacemaker implantation in 1,6%, early prosthetic endocarditis in 0,3%, acute kidney injury in 10,6%, stroke in 1%<span style="color:#222222">, redo surgery due to cardiac tamponade in 1,6%.&nbsp;Four patients (0,7%)&nbsp;needed intra-operative conversion to sternotomy. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000">The mean timing to discharge was 5,8&plusmn;3,6days. The 30-day mortality was 0,7%. In the mid-term follow-up period analysis, the 4-year survival rate was 96,4&plusmn;2,7% and the 4-year time free of MACCE events was 94,7&plusmn;3,8%. About patients over 75years old, the 30-day mortality was 0,6%. In the mid-term follow-up period, the 4-year survival rate was 94,4&plusmn;4,3% and the 4-year time free of MACCE events was 93,2&plusmn;4,8%.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000">CONCLUSIONS: From the perspective of saving lives, the results of single center casuistic about minimally invasive aortic valve replacement approach were very acceptable according to literature and showed the way we should adopt to improve as quality of life. Even in selected older patients as an alternative this procedure showed to be very safe and effective. </span></span></span></p>