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      Aortic valve replacement in patients with a left ventricular ejection fraction ≤35% performed via a minimally invasive right thoracotomy

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          Abstract

          Background

          We evaluated the outcomes of patients with aortic valve pathology in the setting of a left ventricular ejection fraction ≤35% who underwent minimally invasive aortic valve replacement (AVR), with or without concomitant mitral valve (MV) surgery.

          Methods

          All minimally invasive AVR in patients with a left ventricular ejection fraction ≤35%, performed via a right thoracotomy for aortic stenosis or regurgitation between January 2009 and March 2013, were retrospectively evaluated. The operative characteristics, perioperative outcomes, and 30-day mortality were analyzed.

          Results

          There were 75 patients identified: 51 who underwent isolated AVR, and 24 who had combined AVR plus MV surgery for moderate to severe mitral regurgitation. In patients undergoing MV surgery, there were 22 (91.7%) MV repairs [ring annuloplasty =7 (37.5%), transaortic edge-to-edge repair =15 (62.5%)], and 2 (8.3%) replacements. No patient required conversion to sternotomy for inadequate surgical field exposure. The median total mechanical ventilation time and intensive care unit length of stay were 14 (IQR, 8–20) and 42 hours (IQR, 26–93 hours) in the isolated AVR group, and 16.5 hours (IQR, 12–61.5 hours) and 95.5 hours (IQR, 43.5–159 hours) in the AVR plus MV surgery group, respectively. The most common post-operative complication was new-onset atrial fibrillation, which occurred in 15 (29.4%) isolated AVR and 4 (16.7%) AVR plus MV surgery patients. The median hospital length of stay and 30-day mortality was 7 days (IQR, 5–12 days) and 1 (2%) in the isolated AVR group, and 10.5 days (IQR, 5–21 days) and 1 (4.3%) for AVR plus MV surgery.

          Conclusions

          In patients with aortic valve pathology in the setting of a left ventricular ejection fraction ≤35%, minimally invasive AVR can be performed, with or without concomitant MV surgery, with a low morbidity and mortality.

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          Author and article information

          Journal
          J Thorac Dis
          J Thorac Dis
          JTD
          Journal of Thoracic Disease
          AME Publishing Company
          2072-1439
          2077-6624
          June 2017
          June 2017
          : 9
          : Suppl 7
          : S607-S613
          Affiliations
          [1 ]Division of Cardiology, The Columbia University, Mount Sinai Heart Institute , Miami Beach, USA;
          [2 ]Division of Cardiac Surgery, Mount Sinai Heart Institute , Miami Beach, USA;
          [3 ]Department of Anesthesiology, Mount Sinai Medical Center , Miami Beach, USA;
          [4 ]Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School , Boston, USA
          Author notes

          Contributions: (I) Conception and design: O Santana, CG Mihos; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: O Santana, CG Mihos; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

          Correspondence to: Orlando Santana, MD. Director, Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, 4300 Alton Road, Miami Beach, Florida 33140, USA. Email: osantana@ 123456msmc.com .
          Article
          PMC5505940 PMC5505940 5505940 jtd-09-S7-S607
          10.21037/jtd.2017.06.32
          5505940
          28740714
          f1bd1d4b-df04-4660-8078-c3262b164a80
          2017 Journal of Thoracic Disease. All rights reserved.
          Categories
          Original Article

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