Influence of cardiopulmonary bypass set-up and management on clinical outcomes after minimally invasive aortic valve surgery

Introduction: Minimally invasive aortic valve replacement (MIAVR) requires changes in cannulation strategy and cardiopulmonary bypass (CPB) management when compared to the conventional approach (CAVR). We aimed at evaluating if these differences could influence perfusion-related quality parameters and impair postoperative outcomes. Methods: Overall, 339 consecutive patients underwent MIAVR or CAVR between 2014 and 2020 and were analyzed retrospectively. To account for baseline differences, a propensity-matching analysis was performed, obtaining two groups of 97 patients each. Results: MIAVR group had longer CPB time [107 (95–120) vs 95 (86–105) min, p =.003] than CAVR group. Of note, average pump flow rate index [2.4 (2.2–2.5) vs 2.7 (2.4–2.8) l/min/m2, p =.004] was lower in the MIAVR group. Mean arterial pressure was 73 = 9 mmHg vs 62 = 11 mmHg for the MIAVR and CAVR group, respectively (p <.001). Cell-salvaged blood was most commonly used in the MIAVR group (25.8% vs 11.3%, p =.02). Finally, CPB temperature was 32.8°C (32.1–34.8) for MIAVR group vs 34.9°C (33.2–36.1) for the CAVR group (p =.02). Postoperative complications were similar between groups. Conclusions: In conclusion, despite differences in CPB parameters in patients undergoing CAVR and MIAVR, the incidences of adverse outcomes were similar. However, compared to CAVR, MIAVR was associated with shorter durations of mechanical ventilation and hospital stay as well as less transfusion of blood products.