Transaxillary Access for Minimally Invasive Aortic Valve Surgery—Ready for the General Public?

Background: Recently, the transaxillary access has been described as a new access route for minimally invasive aortic valve surgery, but large scaled data are not yet available. Herein we report the clinical performance of this novel access in a large consecutive cohort.

Methods: Between 04/2019 and 12/22 a consecutive cohort of 639 patients underwent isolated aortic valve replacement using the transaxillary access. Data were retrospectively collected out of the hospital’s database and analyzed for pre-, intra- and postoperative variables. Additionally, the proportion of the transaxillary access with regard to all isolated aortic valve procedures was evaluated.

Results: The proportion of the transaxillary access increased from 18.7% (n = 50/268) in 2019 to 90.3% (n = 261/289) in 2022. Basically, the patient population represented a low-risk cohort. Mean age was 68.0 ± 8.1 years, the mean logistic EuroScore was 5.1 ± 4.0% and the EuroScore II averaged 1.7 ± 1.1%. The predominant sex was male (n = 393; 61.5%). Mean skin-to-skin-time was 127 ± 33 minutes with an average x-clamp time of 43 ± 15 minutes. Conversion to full sternotomy became necessary in 15 patients (2.3%). No patient died intraoperatively. Postoperative event rate was low by means of myocardial infarction (n = 3; 0.5%), any stroke (Rankin ≥1; n = 12; 1.8%), re-exploration for bleeding (n = 49; 7.7%), renal failure (n = 8; 1.3%), permanent pacemaker implantation (n = 43; 6.7%), new onset atrial fibrillation (n = 64; 10.0%) and respiratory failure (n = 17; 2.7%). Initial ventilation times were predominantly short (<12hrs: n = 571; 89.4%) as the primary ICU-stay was (<24 hours: n = 453; 70.9%). Wound complications were observed in 3.8% (n = 24), consisting of thoracic access (n = 9/23; 37.5%), groin (n = 11/23; 45.8%) or both (n = 4/23; 16.7%). Median hospital stay was 7 days. Hospital mortality rate was 0.9% (n = 6/639) with a low observed/expected ratio of 0.52 based on the EuroScore II. The combined endpoint “MACCE (death, myocardial infarction and stroke)” was met by 18 patients (2.8%). .

Conclusion: The transaxillary access for minimally invasive aortic valve surgery represents a quick, safe and efficient surgical technique. The clinical results provide excellent outcomes by means of survival and MACCE. It has the potential to replace median sternotomy and to become standard access route for an unselected all-comers population.

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Artikel online veröffentlicht:
13. Februar 2024