Minimally Invasive Surgery for High-Risk Subpopulations: Transaxillary Access Enhances Survival in Adipose Patients

M. Wilbring; S. Arzt; A. Petrov; K. Alexiou; K. Matschke; U. Kappert

doi:10.1055/s-0044-1780708

The Thoracic and Cardiovascular Surgeon, Inhaltsverzeichnis

Thorac Cardiovasc Surg 2024; 72(S 01): S1-S68
DOI: 10.1055/s-0044-1780708

Monday, 19 February

Minimalinvasive Herzklappen-Therapie

Minimally Invasive Surgery for High-Risk Subpopulations: Transaxillary Access Enhances Survival in Adipose Patients

Authors

M. Wilbring

¹University Heart Center Dresden, Department of Cardiac Surgery, Dresden, Deutschland
S. Arzt

¹University Heart Center Dresden, Department of Cardiac Surgery, Dresden, Deutschland
A. Petrov

¹University Heart Center Dresden, Department of Cardiac Surgery, Dresden, Deutschland
K. Alexiou

¹University Heart Center Dresden, Department of Cardiac Surgery, Dresden, Deutschland
K. Matschke

¹University Heart Center Dresden, Department of Cardiac Surgery, Dresden, Deutschland
U. Kappert

¹University Heart Center Dresden, Department of Cardiac Surgery, Dresden, Deutschland

Abstract

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Background: Until now, minimally invasive cardiac surgery (MICS) failed to demonstrate survival benefits in a general cardiac surgery population—assumably due to selection bias effects. With this series we evaluate the outcomes of MICS in adipose patients compared with a propensity-matched sternotomy cohort.

Methods: A consecutive cohort of 3.431 patients undergoing isolated elective aortic valve replacement (AVR) was analyzed. Out of these, 200 consecutive patients with a body-mass-index (BMI) >30 g/m² underwent MICS-AVR using the transaxillary access, serving as treatment-group. A corresponding control-group of isolated AVRs by full sternotomy was generated by 1:1 propensity-matching. Matching variables were age, sex, EuroScore II, BMI, ejection fraction, atrial fibrillation, peripheral vascular disease, chronic kidney disease and chronic lung disease. The matched study cohort consisted of 400 patients with a mean age of 68.0 ± 8.3 years, a mean BMI of 34.4 ± 4.0 kg/m², the logistic EuroScore averaged 7.3 ± 7.5% and the EuroScore II was 1.83 ± 1.30% in mean. Male sex was predominant with 59.5% (n = 238).

Results: After matching, MICS and sternotomy-group showed well balanced clinical baselines. Postoperative outcomes were in favor of MICS-AVR concerning hospital death (1.5% vs. 6.0%; p = 0.0319), shorter median hospital stay (7 days vs. 12 days; p < 0.001), onset of any wound complications (5.0% vs. 12.0%, p = 0.0123), proportion of initial ventilation time less 12h (90.5% vs. 23.5%; p < 0.001), less postoperative renal replacement therapy (2.0% vs. 9.0%; p = 0.0034), less transfusions of PRBC (0.5 ± 1.7 vs. 5.2 ± 9.4; p < 0.001) and FFP (1.0 ± 2.9 vs. 7.7 ± 11.6; p = 0.0222). Stroke rate was comparable (MICS 0.5% and sternotomy 1.0%; p = 0.618). Surgery time was longer in MICS-AVR (135 ± 38min vs. 122 ± 34min; p < 0.001). The combined MACCE-endpoint (Death, stroke, myocardial infarction) was less frequently met in MICS-AVR (2.0% vs. 7.5%; p = 0.0032).

Conclusion: MICS-AVR using the transaxillary access demonstrated significantly better survival and less postoperative morbidity in adipose patients compared with the propensity-matched sternotomy-control.