Tesi etd-10102019-221415
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Tipo di tesi
Master univ. II liv.
Autore
CALLE VALDA, CORAZON MABEL
URN
etd-10102019-221415
Titolo
PROPENSITY-MATCHED COMPARISON BETWEEN MINIMALLY INVASIVE AND CONVENTIONAL STERNOTOMY IN AORTIC VALVE REPLACEMENT: EXPERIENCE IN A SPANISH TERTIARY HOSPITAL
Scientific disciplinary sector
SECS-P/08
Corso di studi
Innovation in Cardiac Surgery: Advances in Minimally Invasive Therapeutics
Commissione
Tutor Prof. PASSINO, CLAUDIO
Tutor Dott. SOLINAS, MARCO
Tutor Dott. SOLINAS, MARCO
Parole chiave
- aortic valve
- cardiac surgery
- minimally invasive
Data inizio appello
31/10/2019;
Disponibilità
completa
Riassunto analitico
Traditionally, the conventional approach for aortic valve replacement was through a complete median sternotomy. However, the rapid development and improvement of new surgical techniques, has allowed the realization of new approaches such as minimally invasive surgery that has revolutionized many facets of surgical practice in cardiac surgery and pretend to be an alternative to surgery with results at least equivalent to conventional surgery.
In this sense, the main objective is oriented to the analysis and comparison of the short and medium term results of the aortic valve replacement regarding the surgical approach: conventional surgery and minimally invasive surgery.
For this purpose, a retrospective cohort study was made with prospectively collected data on 371 patients undergoing aortic valve replacement between 2014 and 2018 at the “Hospital Universitario de la Princesa” in Madrid. Of the 371 patients, 296 belonged to the conventional surgery (CAVR) group and 75 to the minimally invasive aortic surgery group (MIAVR). To provide equivalence among the comparison groups, a multinomial "propensity score matching" 1: 1 analysis was performed and two patient cohorts were identified and selected statistically.
Among highlights of the results in this study, we observed that surgical times reflected a longer trend in the minimally invasive group compared to conventional surgery, though the difference is not statistically significant. Two patients in the minimally invasive group required conversion to a full sternotomy due to poor exposure of the aortic annulus. As regards complications, the minimally invasive surgery group showed a decreased incidence of new onset postoperative atrial fibrillation. However, more pneumothorax and pleural effusion were observed.
Additionally, the total hospitalization time, the MIAVR group presented shorter stays. During follow-up, no differences in mortality and survival were observed in the two groups. As regards the learning curve of the MIAVR group, was necessary a minimum of 27-30 cases to achieve these competences.
In conclusion, we can say that the two approaches for aortic replacement offer excellent results depending on the characteristics of each patient. A correct selection of patients by the "Heart Team" is fundamental to offer each individual the best possible treatment based on the available scientific evidence and the experience of each center.
In this sense, the main objective is oriented to the analysis and comparison of the short and medium term results of the aortic valve replacement regarding the surgical approach: conventional surgery and minimally invasive surgery.
For this purpose, a retrospective cohort study was made with prospectively collected data on 371 patients undergoing aortic valve replacement between 2014 and 2018 at the “Hospital Universitario de la Princesa” in Madrid. Of the 371 patients, 296 belonged to the conventional surgery (CAVR) group and 75 to the minimally invasive aortic surgery group (MIAVR). To provide equivalence among the comparison groups, a multinomial "propensity score matching" 1: 1 analysis was performed and two patient cohorts were identified and selected statistically.
Among highlights of the results in this study, we observed that surgical times reflected a longer trend in the minimally invasive group compared to conventional surgery, though the difference is not statistically significant. Two patients in the minimally invasive group required conversion to a full sternotomy due to poor exposure of the aortic annulus. As regards complications, the minimally invasive surgery group showed a decreased incidence of new onset postoperative atrial fibrillation. However, more pneumothorax and pleural effusion were observed.
Additionally, the total hospitalization time, the MIAVR group presented shorter stays. During follow-up, no differences in mortality and survival were observed in the two groups. As regards the learning curve of the MIAVR group, was necessary a minimum of 27-30 cases to achieve these competences.
In conclusion, we can say that the two approaches for aortic replacement offer excellent results depending on the characteristics of each patient. A correct selection of patients by the "Heart Team" is fundamental to offer each individual the best possible treatment based on the available scientific evidence and the experience of each center.
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