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Totally Endoscopic Aortic Valve Replacement: One-year Follow-up
Jade Claessens, Silke Vangenechten, Loren Packlé, Abdullah Kaya, Alaaddin Yilmaz.
Jessa Hospital, Hasselt, Belgium.

OBJECTIVE:
In the field of aortic valve replacement, new minimally invasive techniques are being developed to reduce trauma and improve cosmetic results. Knowledge concerning clinical outcomes of totally endoscopic aortic valve replacement (TE-AVR) is still limited. METHODS: In this single-center retrospective study, 100 patients underwent TE-AVR between November 2019 and September 2020. Aortic access is gained by a 20 mm working port in the 2nd intercostal space and two 5 mm trocars using zero-degree optics. Peripheral cardiopulmonary bypass is initiated, followed by transthoracic aortic cross-clamping and antegrade administration of a single shot cold mixed-blood cardioplegia. The primary outcomes are major adverse cardiac and cerebrovascular events (MACCE; all-cause mortality, non-fatal stroke or myocardial infarction and reoperation of the replaced valve), 30-day mortality, and all-cause mortality. Patients were followed up for one year after the surgery.
RESULTS: The occurrence of MACCE within 30 days after the surgery was 1%. Additionally, after one year, freedom from MACCE was 96.5% (figure 1A). These MACCEs included two strokes and one reoperation to replace the aortic valve prosthesis. The 30-day mortality rate was 0%, while the freedom from all-cause mortality at the end of follow-up was 93.5% (figure 1B). Additionally, the mean cross-clamp and cardiopulmonary bypass times were 68.43 ± 19.98 and 96.21 ± 24.58 minutes, respectively. Patients remained at the ICU for 44.33 ± 39.08 hours and at the hospital for 5.34 ± 3.56 days. Lastly, the perioperative blood loss (24h) was 304.5 ± 286.41 ml.
CONCLUSIONS: These results of TE-AVR are promising, with good MACCE and morbidity rates. This technique with minimal surgical trauma can be considered safe and feasible. However, there is still room for improvement. Future research should focus on prospective interventional trials to further improve the outcomes.


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