The transaxillary concept for minimally invasive isolated aortic valve replacement: results of 1,000 consecutive patients

Manuel Wilbring; Sebastian Arzt; Ali Taghizadeh-Waghefi; Asen Petrov; Marco Di Eusanio; Klaus Matschke; Konstantin Alexiou; Utz Kappert

doi:10.1093/ejcts/ezae427

The transaxillary concept for minimally invasive isolated aortic valve replacement: results of 1,000 consecutive patients

Eur J Cardiothorac Surg. 2024 Nov 27:ezae427. doi: 10.1093/ejcts/ezae427. Online ahead of print.

Authors

Manuel Wilbring^{1

2}, Sebastian Arzt^{1

2}, Ali Taghizadeh-Waghefi^{1

2}, Asen Petrov^{1

2}, Marco Di Eusanio³, Klaus Matschke^{1

2}, Konstantin Alexiou^{1

2}, Utz Kappert^{1

2}

Affiliations

¹ Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.
² Department of Cardiac Surgery, Faculty of Medicine, and University Hospital Carl Gustav Carus, TU, Dresden, Dresden Heart Centre, Fetscherstraße 74, 01307, Dresden, Germany.
³ Department of Cardiac Surgery, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy.

PMID: 39602603
DOI: 10.1093/ejcts/ezae427

Abstract

Objectives: The transaxillary concept for MICS-AVR is a new and versatile approach with nearly no visible scars. Due to its novelty, available data in literature is scarce. This study reports clinical outcomes of 1,000 consecutive patients.

Methods: Between 2019 and 2023, 4,394 patients underwent elective isolated aortic valve procedures, with 2,958 (67.5%) TAVI's and 1,436 patients SAVR`s (32.5%). Within this period, first consecutive 1,000 transaxillary isolated MICS-AVR were enrolled. Endocarditis, redo's or combined procedures were excluded. Mean age was 67.9 ± 8.3 years, STS-PROM 1.39 ± 2.89% and EuroScore II 1.65 ± 1.12%.

Results: Use of the transaxillary access increased from 18.7% (2019) to 97.8% (2023). Mean procedure-time was 127 ± 31 min, average cross-clamp 43 ± 14 min. Used prostheses were rapid deployment (81.1%), sutured biologic (14.5%) or sutured mechanical valves (4.1%). Conversion-rate was 1.9%. No patient died intraoperatively. Thirty-days MACCE was 1.9% including 0.9% mortality, 0.8% perioperative stroke and 0.6% myocardial infarction. Multivariate factors for MACCE are intraoperative conversion (OR 1.08 [1.00-1.16]; p = 0.04), intraoperative transfusions (OR 1.21 [1.07-1.38]; p < 0.01) and respiratory failure (OR 1.39 [1.30-1.49]; p < 0.01). Corresponding factors for mortality are diabetes on insulin (OR 1.02 [1.00-1.04]; p = 0.03), pure aortic regurgitation for primary indication (OR 1.03 [1.01-1.05]; p < 0.01), intraoperative conversion (OR 1.11 [1.07-1.16]; p < 0.01), renal failure (OR 1.08 [1.05-1.10]; p < 0.01) and respiratory failure (OR 1.22 [1.17-1.26]; p < 0.01).

Conclusions: Transaxillary MICS-AVR is a safe, effective and cosmetically convincing method for SAVR, having the potential for >95.0% MICS-rate in selected patients.

Keywords: Aortic valve replacement; MICLAT S; MICS; Minimally invasive; SAVR; transaxillary.