Short And Long-Term Outcomes Of Minimally Invasive Aortic Valve Surgery According To Pleural Integrity Preservation.

Background Pleura integrity is a significant parameter influencing the outcomes in conventional cardiac surgery interventions. The impact of pleural integrity preservation in minimally invasive surgery is still not widely investigated. This study aims to define the role of pleural integrity preservation (PPI) on short and long-term outcomes after minimally-invasive aortic valve replacement (MIAVR). METHODS Data from 2430 consecutive patients who underwent MIAVR between 1997-2022 were retrospectively collected. Patients were divided into two groups: patients with PPI versus not-pleura integrity preservation (not-PPI). PPI has considered the maintenance of the pleura closed without the need for a chest tube insertion at the end of the surgical procedure. The not-PPI group included patients treated by right anterior Mini-Thoracotomy (824) or Ministernotomy (154) requiring surgical pleural drainage. A propensity-matched analysis was used to compare the two groups (not-PPI vs PPI). The main outcome was all-cause incidence of postoperative respiratory complications. RESULTS After propensity-matching, 848 patients were included in each group (PPI and not-PPI). Mean followup time was 147.4 months. Post-operatively, not-PPI vs PPI patients had a longer intensive care unit stay (hours) (9.7 vs 17.3, p= 0.00003, respectively), and hospital length of stay (LOS) (days) (5.2 vs 8.9, p= 0.00002, respectively). The rate of respiratory complications, including incidence of pneumothorax and/or subcutaneous emphysema, pulmonary atelectasis, and pleural effusion events requiring thoracentesis/drainage, was significantly higher in the not-PPI vs PPI group. Thirty-day all-cause mortality was higher in not-PPI vs PPI (0.029 vs 0.010, p= 0.0028, respectively), (Table 1). CONCLUSIONS Not-PPI after MIAVR was associated with an increased incidence of postoperative complications, and increased LOS compared to PPI. Even long term survival was significantly better in the PPI group. Particularly, the not-PPI approach increased 4 folds the probability of long-term mortality. Therefore, a MIAVR-tailored patient-procedure approach to maintaining the pleura integrity seems positively impacts short- and long-term outcomes. [ABSTRACT FROM AUTHOR]