Minimally Invasive Versus Full Sternotomy for Isolated Aortic Valve Replacement in Low-Risk Patients

Mark J. Russo; Vinod H. Thourani; David J. Cohen; S. Chris Malaisrie; Wilson Y. Szeto; Isaac George; Susheel K. Kodali; Raj Makkar; Michael Lu; Mathew Williams; Tom Nguyen; Gabriel Aldea; Philippe Genereux; H. Kenith Fang; Maria C. Alu; Erin Rogers; Alexis Okoh; Howard C. Herrmann; Samir Kapadia; John G. Webb; Craig R. Smith; Martin B. Leon; Michael J. Mack

doi:10.1016/j.athoracsur.2021.11.048

Minimally Invasive Versus Full Sternotomy for Isolated Aortic Valve Replacement in Low-Risk Patients

Mark J. Russo^*, Vinod H. Thourani, David J. Cohen, S. Chris Malaisrie, Wilson Y. Szeto, Isaac George, Susheel K. Kodali, Raj Makkar, Michael Lu, Mathew Williams, Tom Nguyen, Gabriel Aldea, Philippe Genereux, H. Kenith Fang, Maria C. Alu, Erin Rogers, Alexis Okoh, Howard C. Herrmann, Samir Kapadia, John G. WebbCraig R. Smith, Martin B. Leon, Michael J. Mack

^*Corresponding author for this work

Surgery, Cardiac Surgery Division

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

Abstract

Background: Surgical aortic valve replacement can be performed through a minimally invasive (MI) or full sternotomy (FS) approach. The present study compared outcomes of MI vs FS for isolated surgery among patients enrolled in the Placement of Aortic Transcatheter Valves (PARTNER) 3 low-risk trial. Methods: Patients with severe, symptomatic aortic stenosis at low surgical risk with anatomy suitable for transfemoral access were eligible for PARTNER 3 enrollment. The primary outcome was the composite end point of death, stroke, or rehospitalization (valve-, procedure-, or heart failure-related) at 1 year. Secondary outcomes included the individual components of the primary end point as well as patient-reported health status at 30 days and 1 year. Results: In the PARTNER 3 study, 358 patients underwent isolated valve replacement at 68 centers through an MI (n = 107) or FS (n = 251) approach (8 patients were converted from MI to FS). Mean age and Society of Thoracic Surgeons score were similar between groups. The Kaplan-Meier estimate of the primary outcome was similar in the MI vs FS groups (16.9% vs 14.9%; hazard ratio, 1.15; 95% CI, 0.66-2.03; P =. 618). There were no significant differences in the 1-year rates of all-cause death (2.8% vs 2.8%), all stroke (1.9% vs 3.6%), or rehospitalization (13.3% vs 10.6%, P >. 05 for all). Quality of life, as assessed by the Kansas City Cardiomyopathy Questionnaire score at 30 days or 1 year, was comparable in both groups. Conclusions: For patients at low risk for isolated surgery, MI and FS approaches were associated with similar in-hospital and 1-year outcomes.

Original language	English (US)
Pages (from-to)	2124-2130
Number of pages	7
Journal	Annals of Thoracic Surgery
Volume	114
Issue number	6
DOIs	https://doi.org/10.1016/j.athoracsur.2021.11.048
State	Published - Dec 2022

Funding

The authors wish to acknowledge Gayle Scott, Marissa Gunnarsson, and Xiao Yu, who are employees of Edwards Lifesciences, for providing editing support. The PARTNER 3 trial was funded by Edwards Lifesciences. Mark J. Russo, Vinod H. Thourani, and Michael J. Mack have received grants from Edwards Lifesciences. David J. Cohen has received grants from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott Vascular. Susheel K. Kodali has received grants from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott. Raj Makkar has received grants from Edwards Lifesciences and Abbott. Mathew Williams has received research support from Edwards Lifesciences. Maria C. Alu has received institutional research support from Edwards Lifesciences and Abbott. Howard C. Herrmann has received institutional research funding from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic. Martin B. Leon has received grants from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott. Michael J. Mack has received nonfinancial support from Edwards Lifesciences, Medtronic, and Abbott. The authors wish to acknowledge Gayle Scott, Marissa Gunnarsson, and Xiao Yu, who are employees of Edwards Lifesciences, for providing editing support. The PARTNER 3 trial was funded by Edwards Lifesciences. Mark J. Russo, Vinod H. Thourani, and Michael J. Mack have received grants from Edwards Lifesciences . David J. Cohen has received grants from Edwards Lifesciences, Medtronic , Boston Scientific , and Abbott Vascular . Susheel K. Kodali has received grants from Edwards Lifesciences, Medtronic , Boston Scientific, and Abbott. Raj Makkar has received grants from Edwards Lifesciences and Abbott . Mathew Williams has received research support from Edwards Lifesciences. Maria C. Alu has received institutional research support from Edwards Lifesciences and Abbott. Howard C. Herrmann has received institutional research funding from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic. Martin B. Leon has received grants from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott. Michael J. Mack has received nonfinancial support from Edwards Lifesciences, Medtronic, and Abbott.

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Pulmonary and Respiratory Medicine
Surgery

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10.1016/j.athoracsur.2021.11.048

Cite this

Russo, M. J., Thourani, V. H., Cohen, D. J., Malaisrie, S. C., Szeto, W. Y., George, I., Kodali, S. K., Makkar, R., Lu, M., Williams, M., Nguyen, T., Aldea, G., Genereux, P., Fang, H. K., Alu, M. C., Rogers, E., Okoh, A., Herrmann, H. C., Kapadia, S., ... Mack, M. J. (2022). Minimally Invasive Versus Full Sternotomy for Isolated Aortic Valve Replacement in Low-Risk Patients. Annals of Thoracic Surgery, 114(6), 2124-2130. https://doi.org/10.1016/j.athoracsur.2021.11.048

@article{b973f80ed1134d7192d6880be33abfea,

title = "Minimally Invasive Versus Full Sternotomy for Isolated Aortic Valve Replacement in Low-Risk Patients",

abstract = "Background: Surgical aortic valve replacement can be performed through a minimally invasive (MI) or full sternotomy (FS) approach. The present study compared outcomes of MI vs FS for isolated surgery among patients enrolled in the Placement of Aortic Transcatheter Valves (PARTNER) 3 low-risk trial. Methods: Patients with severe, symptomatic aortic stenosis at low surgical risk with anatomy suitable for transfemoral access were eligible for PARTNER 3 enrollment. The primary outcome was the composite end point of death, stroke, or rehospitalization (valve-, procedure-, or heart failure-related) at 1 year. Secondary outcomes included the individual components of the primary end point as well as patient-reported health status at 30 days and 1 year. Results: In the PARTNER 3 study, 358 patients underwent isolated valve replacement at 68 centers through an MI (n = 107) or FS (n = 251) approach (8 patients were converted from MI to FS). Mean age and Society of Thoracic Surgeons score were similar between groups. The Kaplan-Meier estimate of the primary outcome was similar in the MI vs FS groups (16.9% vs 14.9%; hazard ratio, 1.15; 95% CI, 0.66-2.03; P =. 618). There were no significant differences in the 1-year rates of all-cause death (2.8% vs 2.8%), all stroke (1.9% vs 3.6%), or rehospitalization (13.3% vs 10.6%, P >. 05 for all). Quality of life, as assessed by the Kansas City Cardiomyopathy Questionnaire score at 30 days or 1 year, was comparable in both groups. Conclusions: For patients at low risk for isolated surgery, MI and FS approaches were associated with similar in-hospital and 1-year outcomes.",

author = "Russo, {Mark J.} and Thourani, {Vinod H.} and Cohen, {David J.} and Malaisrie, {S. Chris} and Szeto, {Wilson Y.} and Isaac George and Kodali, {Susheel K.} and Raj Makkar and Michael Lu and Mathew Williams and Tom Nguyen and Gabriel Aldea and Philippe Genereux and Fang, {H. Kenith} and Alu, {Maria C.} and Erin Rogers and Alexis Okoh and Herrmann, {Howard C.} and Samir Kapadia and Webb, {John G.} and Smith, {Craig R.} and Leon, {Martin B.} and Mack, {Michael J.}",

note = "Publisher Copyright: {\textcopyright} 2022 The Society of Thoracic Surgeons",

year = "2022",

month = dec,

doi = "10.1016/j.athoracsur.2021.11.048",

language = "English (US)",

volume = "114",

pages = "2124--2130",

journal = "Annals of Thoracic Surgery",

issn = "0003-4975",

publisher = "Elsevier USA",

number = "6",

}

Russo, MJ, Thourani, VH, Cohen, DJ, Malaisrie, SC, Szeto, WY, George, I, Kodali, SK, Makkar, R, Lu, M, Williams, M, Nguyen, T, Aldea, G, Genereux, P, Fang, HK, Alu, MC, Rogers, E, Okoh, A, Herrmann, HC, Kapadia, S, Webb, JG, Smith, CR, Leon, MB & Mack, MJ 2022, 'Minimally Invasive Versus Full Sternotomy for Isolated Aortic Valve Replacement in Low-Risk Patients', Annals of Thoracic Surgery, vol. 114, no. 6, pp. 2124-2130. https://doi.org/10.1016/j.athoracsur.2021.11.048

TY - JOUR

T1 - Minimally Invasive Versus Full Sternotomy for Isolated Aortic Valve Replacement in Low-Risk Patients

AU - Russo, Mark J.

AU - Thourani, Vinod H.

AU - Cohen, David J.

AU - Malaisrie, S. Chris

AU - Szeto, Wilson Y.

AU - George, Isaac

AU - Kodali, Susheel K.

AU - Makkar, Raj

AU - Lu, Michael

AU - Williams, Mathew

AU - Nguyen, Tom

AU - Aldea, Gabriel

AU - Genereux, Philippe

AU - Fang, H. Kenith

AU - Alu, Maria C.

AU - Rogers, Erin

AU - Okoh, Alexis

AU - Herrmann, Howard C.

AU - Kapadia, Samir

AU - Webb, John G.

AU - Smith, Craig R.

AU - Leon, Martin B.

AU - Mack, Michael J.

PY - 2022/12

Y1 - 2022/12

N2 - Background: Surgical aortic valve replacement can be performed through a minimally invasive (MI) or full sternotomy (FS) approach. The present study compared outcomes of MI vs FS for isolated surgery among patients enrolled in the Placement of Aortic Transcatheter Valves (PARTNER) 3 low-risk trial. Methods: Patients with severe, symptomatic aortic stenosis at low surgical risk with anatomy suitable for transfemoral access were eligible for PARTNER 3 enrollment. The primary outcome was the composite end point of death, stroke, or rehospitalization (valve-, procedure-, or heart failure-related) at 1 year. Secondary outcomes included the individual components of the primary end point as well as patient-reported health status at 30 days and 1 year. Results: In the PARTNER 3 study, 358 patients underwent isolated valve replacement at 68 centers through an MI (n = 107) or FS (n = 251) approach (8 patients were converted from MI to FS). Mean age and Society of Thoracic Surgeons score were similar between groups. The Kaplan-Meier estimate of the primary outcome was similar in the MI vs FS groups (16.9% vs 14.9%; hazard ratio, 1.15; 95% CI, 0.66-2.03; P =. 618). There were no significant differences in the 1-year rates of all-cause death (2.8% vs 2.8%), all stroke (1.9% vs 3.6%), or rehospitalization (13.3% vs 10.6%, P >. 05 for all). Quality of life, as assessed by the Kansas City Cardiomyopathy Questionnaire score at 30 days or 1 year, was comparable in both groups. Conclusions: For patients at low risk for isolated surgery, MI and FS approaches were associated with similar in-hospital and 1-year outcomes.

AB - Background: Surgical aortic valve replacement can be performed through a minimally invasive (MI) or full sternotomy (FS) approach. The present study compared outcomes of MI vs FS for isolated surgery among patients enrolled in the Placement of Aortic Transcatheter Valves (PARTNER) 3 low-risk trial. Methods: Patients with severe, symptomatic aortic stenosis at low surgical risk with anatomy suitable for transfemoral access were eligible for PARTNER 3 enrollment. The primary outcome was the composite end point of death, stroke, or rehospitalization (valve-, procedure-, or heart failure-related) at 1 year. Secondary outcomes included the individual components of the primary end point as well as patient-reported health status at 30 days and 1 year. Results: In the PARTNER 3 study, 358 patients underwent isolated valve replacement at 68 centers through an MI (n = 107) or FS (n = 251) approach (8 patients were converted from MI to FS). Mean age and Society of Thoracic Surgeons score were similar between groups. The Kaplan-Meier estimate of the primary outcome was similar in the MI vs FS groups (16.9% vs 14.9%; hazard ratio, 1.15; 95% CI, 0.66-2.03; P =. 618). There were no significant differences in the 1-year rates of all-cause death (2.8% vs 2.8%), all stroke (1.9% vs 3.6%), or rehospitalization (13.3% vs 10.6%, P >. 05 for all). Quality of life, as assessed by the Kansas City Cardiomyopathy Questionnaire score at 30 days or 1 year, was comparable in both groups. Conclusions: For patients at low risk for isolated surgery, MI and FS approaches were associated with similar in-hospital and 1-year outcomes.

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UR - http://www.scopus.com/inward/citedby.url?scp=85127771063&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2021.11.048

DO - 10.1016/j.athoracsur.2021.11.048

M3 - Article

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AN - SCOPUS:85127771063

SN - 0003-4975

VL - 114

SP - 2124

EP - 2130

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

IS - 6

ER -

Minimally Invasive Versus Full Sternotomy for Isolated Aortic Valve Replacement in Low-Risk Patients

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