[Pulmonary complications after minimally invasive aortic valve replacement surgery - a propensity score matching analysis].

Instruction: To answer the question if minimally invasive aortic valve replacement surgery through a right anterior minithoracotomy (RT-AVR) may result in increased incidence of postoperative pulmonary complications compared to conventional aortic valve replacement through a median sternotomy (AVR).

Material and methods: It was retrospective analysis of 212 patients scheduled for RT-AVR and 212 for AVR between January 2011 and December 2014 selected with propensity score matching. Respiratory system complications are analysed.

Results: Postoperative blood drainage was 353±249 and 524±325 ml in RT-AVR and AVR groups respectively (p<0.001). Hospital stay was 5.7±1.6 and 8.5±4.3 days (p<0.001), ICU stay was 1.3±1.2 and 2.6±2.8 days (p<0.001) in RT-AVR and AVR patients respectively. Respiratory system complications occurred in 13.7% of RT-AVR patients and 17.0% of AVR patients (p=0.364). Pneumonia was diagnosed in 2.4% and 0.5% of patients (p=0.129), pneumothorax in 2.0% and 1.3% of patients (p=0.515), pleural effusion in 8.5% and 7.5% of patients (p =0.732) and thoracentesis was performed in 7.1% and 7.5% of patients from RT-AVR and AVR groups respectively. Mediastinitis was diagnosed in 0.0% of RT-AVR and 2.8% of AVR patients (p=0.020). Phrenic nerve dysfunction was present in 3.8% of RT-AVR and in 0.0% of AVR patients (p=0.006). COPD (OR=5.5; p<0.001) and increased postoperative blood loss (OR=3.5; p<0.001) were risk factors of postoperative pulmonary complications.

Conclusion: Minimally invasive RT-AVR surgery did not result in increased rate of postoperative pulmonary complications compared to conventional AVR surgery through a median sternotomy.