Journal Article

Bleeding in minimally invasive versus conventional aortic valve replacement

Bratt, Sorosh, Franco-Cereceda, Anders, Lilford, Robert D., Sartipy, Ulrik, Dalén, Magnus, Dimberg, Axel, Kastengren, Mikael, Svenarud, Peter

2024

Overview

Background Observational studies have shown reduced perioperative bleeding in patients undergoing minimally invasive, compared with full sternotomy, aortic valve replacement. Data from randomized trials are conflicting. Methods This was a Swedish single center study where adult patients with aortic stenosis, 100 patients were randomly assigned in a 1:1 ratio to undergo either minimally invasive (ministernotomy) or full sternotomy aortic valve replacement. The primary outcome was severe or massive bleeding defined by the Universal Definition of Perioperative Bleeding in adult cardiac surgery (UDPB). Secondary outcomes included blood product transfusions, chest tube output, re-exploration for bleeding, and several other clinically relevant events. Results Out of 100 patients, three patients randomized to ministernotomy were intraoperatively converted to full sternotomy (none was bleeding-related). Three patients (6%) in the full sternotomy group and 3 patients (6%) in the ministernotomy group suffered severe or massive postoperative bleeding according to the UDPB definition ( p  = 1.00). Mean chest tube output during the first 12 postoperative hours was 350 (standard deviation (SD) 220) ml in the full sternotomy group and 270 (SD 190) ml in the ministernotomy group ( p  = 0.08). 28% of patients in the full sternotomy group and 36% of patients in the ministernotomy group received at least one packed red blood cells transfusion ( p  = 0.39). Two patients in each group (4%) underwent re-exploration for bleeding. Conclusions Minimally invasive aortic valve replacement did not result in less bleeding-related outcomes compared to full sternotomy. Clinical Trial Registration http://www.clinicaltrials.gov . Unique identifier: NCT02272621.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Aged, 80 and over / Anticoagulants / Aorta / Aortic stenosis / Aortic valve / Aortic Valve - surgery / Aortic valve stenosis / Aortic Valve Stenosis - surgery / Biological products / Bleeding / Blood / Blood coagulation factors / Blood Loss, Surgical - prevention & control / Blood transfusion / Cardiac Surgery / Chest / Chest tubes / Clinical trials / Clopidogrel / Comparative analysis / Coronary vessels / Data collection / Erythrocytes / Exploration / Female / Heart surgery / Heart Valve Prosthesis Implantation - adverse effects / Heart Valve Prosthesis Implantation - methods / Heart valves / Hospitals / Humans / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Middle Aged / Minimally invasive surgery / Minimally Invasive Surgical Procedures - methods / Ministernotomy / Mortality / Patients / Pericardium / Postoperative Hemorrhage / Sternotomy - adverse effects / Sternotomy - methods / Surgeons / Sweden / Thoracic Surgery / Tranexamic acid / Treatment Outcome