Outcomes of the Valve-Sparing Root Replacement Procedure with Partial Upper Sternotomy

Due to better postoperative convalescence and quality of life, experienced centers focus on minimally invasive surgical techniques and approaches, but this approach is not routinely performed for valve-sparing root replacement procedures. The purpose of this study was to assess the safety and feasib...

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Autores principales:	Bin Hou, Rui Zhao, De Wang, Wei Wang, Zhenhua Zhao, Xiaogang Sun, Xiangyang Qian, Cuntao Yu
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	minimally invasive valve-sparing root replacement DAVID procedure aortic aneurysm propensity-matched analysis Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/680efb83ca724285a9e66a80f3526d01
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spelling	oai:doaj.org-article:680efb83ca724285a9e66a80f3526d012021-11-25T18:00:24ZOutcomes of the Valve-Sparing Root Replacement Procedure with Partial Upper Sternotomy10.3390/jcdd81101542308-3425https://doaj.org/article/680efb83ca724285a9e66a80f3526d012021-11-01T00:00:00Zhttps://www.mdpi.com/2308-3425/8/11/154https://doaj.org/toc/2308-3425Due to better postoperative convalescence and quality of life, experienced centers focus on minimally invasive surgical techniques and approaches, but this approach is not routinely performed for valve-sparing root replacement procedures. The purpose of this study was to assess the safety and feasibility of valve-sparing root replacement via partial upper sternotomy. Between January 2016 and April 2021, 269 patients underwent a valve-sparing root replacement procedure, and partial upper sternotomy was performed in 52 patients. The clinical outcomes of the partial upper sternotomy (PUS) and complete sternotomy (CS) groups, including mortality, degree of aortic insufficiency, blood loss and consumption of blood products, postoperative complications, and hospitalization expenses, were compared. The Kaplan–Meier method was used to assess the degree of aortic regurgitation. Propensity score matching was performed as a sensitivity analysis. There was only one in-hospital death (in the CS group, <i>p</i> = 1) and no postoperative moderate to severe aortic insufficiency in either group. The blood loss and consumption of blood products in the PUS group were also lower than in the CS group, especially for plasma use. Regarding the need for re-exploration because of bleeding, acute kidney injury, pericardial pleural effusion, drainage volume within the first 24 h, mechanical ventilation time, and arrhythmia, the two groups were comparable. Patients in the CS group showed a longer ICU time (74.20 ± 47.21 vs. 50.9 30.16 h, <i>p</i> = 0.001) and higher hospitalization expenses (135,649.52 ± 29,992.21 vs. 123,380.15 ± 27,062.82 yuan, <i>p</i> < 0.001). None of the patients died or reoperated during the follow-up. Freedom from moderate or severe aortic insufficiency remained comparable after matching (<i>p</i> = 0.97). Minimally invasive valve-sparing aortic replacement via partial upper sternotomy can be safely performed in selected patients.Bin HouRui ZhaoDe WangWei WangZhenhua ZhaoXiaogang SunXiangyang QianCuntao YuMDPI AGarticleminimally invasivevalve-sparing root replacementDAVID procedureaortic aneurysmpropensity-matched analysisDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of Cardiovascular Development and Disease, Vol 8, Iss 154, p 154 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	minimally invasive valve-sparing root replacement DAVID procedure aortic aneurysm propensity-matched analysis Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	minimally invasive valve-sparing root replacement DAVID procedure aortic aneurysm propensity-matched analysis Diseases of the circulatory (Cardiovascular) system RC666-701 Bin Hou Rui Zhao De Wang Wei Wang Zhenhua Zhao Xiaogang Sun Xiangyang Qian Cuntao Yu Outcomes of the Valve-Sparing Root Replacement Procedure with Partial Upper Sternotomy
description	Due to better postoperative convalescence and quality of life, experienced centers focus on minimally invasive surgical techniques and approaches, but this approach is not routinely performed for valve-sparing root replacement procedures. The purpose of this study was to assess the safety and feasibility of valve-sparing root replacement via partial upper sternotomy. Between January 2016 and April 2021, 269 patients underwent a valve-sparing root replacement procedure, and partial upper sternotomy was performed in 52 patients. The clinical outcomes of the partial upper sternotomy (PUS) and complete sternotomy (CS) groups, including mortality, degree of aortic insufficiency, blood loss and consumption of blood products, postoperative complications, and hospitalization expenses, were compared. The Kaplan–Meier method was used to assess the degree of aortic regurgitation. Propensity score matching was performed as a sensitivity analysis. There was only one in-hospital death (in the CS group, <i>p</i> = 1) and no postoperative moderate to severe aortic insufficiency in either group. The blood loss and consumption of blood products in the PUS group were also lower than in the CS group, especially for plasma use. Regarding the need for re-exploration because of bleeding, acute kidney injury, pericardial pleural effusion, drainage volume within the first 24 h, mechanical ventilation time, and arrhythmia, the two groups were comparable. Patients in the CS group showed a longer ICU time (74.20 ± 47.21 vs. 50.9 30.16 h, <i>p</i> = 0.001) and higher hospitalization expenses (135,649.52 ± 29,992.21 vs. 123,380.15 ± 27,062.82 yuan, <i>p</i> < 0.001). None of the patients died or reoperated during the follow-up. Freedom from moderate or severe aortic insufficiency remained comparable after matching (<i>p</i> = 0.97). Minimally invasive valve-sparing aortic replacement via partial upper sternotomy can be safely performed in selected patients.
format	article
author	Bin Hou Rui Zhao De Wang Wei Wang Zhenhua Zhao Xiaogang Sun Xiangyang Qian Cuntao Yu
author_facet	Bin Hou Rui Zhao De Wang Wei Wang Zhenhua Zhao Xiaogang Sun Xiangyang Qian Cuntao Yu
author_sort	Bin Hou
title	Outcomes of the Valve-Sparing Root Replacement Procedure with Partial Upper Sternotomy
title_short	Outcomes of the Valve-Sparing Root Replacement Procedure with Partial Upper Sternotomy
title_full	Outcomes of the Valve-Sparing Root Replacement Procedure with Partial Upper Sternotomy
title_fullStr	Outcomes of the Valve-Sparing Root Replacement Procedure with Partial Upper Sternotomy
title_full_unstemmed	Outcomes of the Valve-Sparing Root Replacement Procedure with Partial Upper Sternotomy
title_sort	outcomes of the valve-sparing root replacement procedure with partial upper sternotomy
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/680efb83ca724285a9e66a80f3526d01
work_keys_str_mv	AT binhou outcomesofthevalvesparingrootreplacementprocedurewithpartialuppersternotomy AT ruizhao outcomesofthevalvesparingrootreplacementprocedurewithpartialuppersternotomy AT dewang outcomesofthevalvesparingrootreplacementprocedurewithpartialuppersternotomy AT weiwang outcomesofthevalvesparingrootreplacementprocedurewithpartialuppersternotomy AT zhenhuazhao outcomesofthevalvesparingrootreplacementprocedurewithpartialuppersternotomy AT xiaogangsun outcomesofthevalvesparingrootreplacementprocedurewithpartialuppersternotomy AT xiangyangqian outcomesofthevalvesparingrootreplacementprocedurewithpartialuppersternotomy AT cuntaoyu outcomesofthevalvesparingrootreplacementprocedurewithpartialuppersternotomy
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Outcomes of the Valve-Sparing Root Replacement Procedure with Partial Upper Sternotomy

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