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Minimally Invasive Valve Surgery. Pushing Boundaries Over The Eighty
Cristina Barbero1, Marco Pocar1, Dario Brenna1, Antonio Salsano2, Erik Cura Stura1, Claudia Calia1, Viviana Sebastiano1, Massimo Boffini1, Mauro Rinaldi1, Davide Ricci2.
1Cittą della Salute e delle Scienza, Turin, Italy, 2Department of Integrated Surgical and Diagnostic Sciences, Genova, Italy.

OBJECTIVE: Patients aged more than 80 years now account for a considerable proportion of all comers requiring valve surgery. Obviously, concerns exist regarding the appropriateness of the surgical procedure. Identifying patients who are most likely to have survival and functional benefits after minimally invasive cardiac surgery is decisive to achieve optimal health outcomes and prevent futile procedures. Aim of this study is to identify independent predictors of mid-term mortality in octogenarians patients undergoing minimally invasive mitral valve (MV) and/or tricuspid valve (TV) surgery. METHODS: A single-institution retrospective study was performed between 2006 and 2020. Primary end-point was to identify independent predictors of mid-term mortality. Survival was determined by Kaplan-Meier and multivariable Cox analysis was used for mortality at follow-up. RESULTS:
130 consecutive patients were enrolled. Mean age was 82.0±2.0 year; 17 were redo (13.1%). MV surgery was performed in 123 cases (94.6%); of these, 32.5% were MV repair. Retrograde perfusion was adopted in 92.3% of the cases. Aortic occlusion was obtained with trans-thoracic clamp in 91 cases (70.0%), and with endo-aortic balloon in 34 cases (26.2%). Conversion to sternotomy was required in 2 cases. Stroke occurred in one patient. 30-day mortality was 6%. Mean follow-up was 45±36.7 months. Survival at 1 and 5-years was respectively 86% (95%CI:80-92.4%), and 64% (95%CI:55.1-74.8%). The stepwise multivariable analysis identified age>85 year (HR 3.21, 95%CI:1.52-6.8, p=0.002) and creatinine levels >1.5 mg/dL (HR 2.42, 95%CI:1.18-4.94, p=0.015) as independent predictors of mortality at follow-up. CONCLUSIONS:
Results of the present analysis show that main risk factors for mid-term mortality in octogenarians patients undergoing minimally invasive valve surgery are age >85 years and creatinine level >1.5 mg/dL. A proper and fine patient selection must be the core of a minimally invasive valve program with the plan to avoid profiles with extremely high preoperative risk and, consequently, avoid futile procedures.


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