Cor Vasa 2020, 62(6):578-582 | DOI: 10.33678/cor.2020.096

(Current trend in minimally invasive aortic valve surgery in the Czech Republic)

Ján Gofus^a, Svetlana Drábková^b, Martin Voborník^a, Marek Pojar^a, Jan Vojáček

^a Kardiochirurgická klinika, Lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Hradec Králové, Hradec Králové

^b Ústav zdravotnických informací a statistiky České republiky, Praha

Aims: Minimally invasive surgical approaches to aortic valve replacement are a popular compromise between standard replacement through median sternotomy and transcatheter aortic valve implantation. The aim of our study was to analyze the respective surgical approaches and their outcomes in the last five years in the Czech Republic.

Methods: We conducted a retrospective analysis of all the isolated surgical aortic valve replacements performed in the Czech Republic between 2015 and 2019 from the aspect of surgical approach. For this purpose, we took the cohort data from National Registry of Cardiovascular Surgeries and Interventions. We assessed the size of the cohorts and the early perioperative mortality in all the cohorts in time as well as the early perioperative outcomes.

Results: There is a rising tendency in time towards choosing the minimally invasive approach to aortic valve replacement. In 2019, 287 patients (37.5%) were operated in a minimally invasive manner (27.6% through partial sternotomy, 9.3% through thoracotomy, conversion was required in 0.6%) while preserving stable low mortality and risk of conversion. Minimally invasive cohorts had shorter operation times, shorter artificial ventilation time, and intensive care unit stay. They had lower blood loss, lower need for transfusion, lower risk of conversion and wound infection. However, they had low risk profile according to EuroSCORE II.

Conclusion: In the Czech Republic, there is a favorable trend towards rising use of minimally invasive approaches to isolated aortic valve replacement while preserving stable low mortality. The patients have low risk of complications and the recovery is fast. Minimally invasive approaches to aortic valve replacement should be generally preferred as far as there are no severe contraindications.

Keywords: Aortic valve replacement, Minimally invasive cardiac surgery, Partial sternotomy, Thoracotomy

Received: July 11, 2020; Revised: August 22, 2020; Accepted: October 24, 2020; Published: December 11, 2020  Show citation