Minimally invasive versus standard extracorporeal circulation system in minimally invasive aortic valve surgery: a propensity score-matched study.

Open in new tab Download slide Open in new tab Download slide OBJECTIVES The impact of minimally invasive extracorporeal circulation (MiECC) systems on the clinical outcomes of patients undergoing minimally invasive aortic valve replacement (MI-AVR) has still to be defined. This study compared in-hospital and 1 year outcomes of MI-AVR interventions using MiECC systems versus conventional extracorporeal circulation (c-ECC). METHODS Data from 288 consecutive patients undergoing primary isolated MI-AVR using MiECC (n  = 102) or c-ECC (n  = 186) were prospectively collected. Treatment selection bias was addressed by the use of propensity score matching (MiECC vs c-ECC). After propensity score matching, 2 groups of 93 patients each were created. RESULTS Compared with c-ECC, MiECC was associated with a higher rate of autologous priming (82.4% vs 0%; P  < 0.001) and a greater nadir haemoglobin (9.3 vs 8.7 g/dl; P  = 0.021) level and haematocrit (27.9% vs 26.4%; P  = 0.023). Patients who had MiECC were more likely to receive ultra-fast-track management (60.8% vs 26.9%; P  < 0.001) and less likely to receive blood transfusions (32.7% vs 44%; P  = 0.04). The in-hospital mortality rate was 1.1% in the MiECC group and 0% in the c-ECC group (P  = 0.5). Those in the MiECC group had reduced rates of bleeding requiring revision (0% vs 5.3%; P  = 0.031) and postoperative atrial fibrillation (AF) (30.1% vs 44.1%; P  = 0.034). The 1-year survival rate was 96.8% and 97.5% for MiECC and c-ECC patients, respectively (P  = 0.4). CONCLUSIONS MiECC systems were a safe and effective tool in patients who had MI-AVR. Compared with c-ECC, MiECC promotes ultra-fast-track management and provides better clinical outcomes as regards bleeding, blood transfusions and postoperative AF. Thus, by reducing surgical injury and promoting faster recovery, MiECC may further validate MI-AVR interventions. [ABSTRACT FROM AUTHOR]