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Cerebral microemboli in mini-sternotomy compared to mini- thoracotomy for aortic valve replacement: a cross sectional cohort study
- Source :
- Journal of Cardiothoracic Surgery, Vol 16, Iss 1, Pp 1-9 (2021), Journal of Cardiothoracic Surgery
- Publication Year :
- 2021
- Publisher :
- BMC, 2021.
-
Abstract
- Background Recently 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. Methods Trans-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. Results A 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 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). Conclusion There 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.
- Subjects :
- Male
Time Factors
030204 cardiovascular system & hematology
Mini-sternotomy
law.invention
Cohort Studies
Mini-thoracotomy
0302 clinical medicine
Aortic valve replacement
law
Minimal invasive surgery
Anesthesiology
RD78.3-87.3
Prospective Studies
Cognitive test
Intraoperative Complications
Heart Valve Prosthesis Implantation
Body surface area
Cardiopulmonary Bypass
Age Factors
General Medicine
Middle Aged
Cardiac surgery
Intracranial Embolism
Thoracotomy
Cardiothoracic surgery
Aortic Valve
Cardiology
Female
Cardiology and Cardiovascular Medicine
Research Article
Cohort study
Pulmonary and Respiratory Medicine
medicine.medical_specialty
RD1-811
03 medical and health sciences
medicine.artery
Internal medicine
Ascending aorta
Cardiopulmonary bypass
medicine
Humans
Minimally Invasive Surgical Procedures
Cognitive Dysfunction
Microembolic signals
Aged
business.industry
Transcranial Doppler
Ultrasonography, Doppler
Length of Stay
medicine.disease
Sternotomy
Cross-Sectional Studies
030228 respiratory system
Surgery
business
Subjects
Details
- Language :
- English
- ISSN :
- 17498090
- Volume :
- 16
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Journal of Cardiothoracic Surgery
- Accession number :
- edsair.doi.dedup.....87e37e2193cf2755dfdf1cb9475c445b