Changwon Shin, M.D., Min Ho Ju, M.D., Chee-Hoon Lee, M.D., Mi Hee Lim, M.D., Ph.D., Hyung Gon Je, M.D., Ph.D.. J Chest Surg 2023;56:42-8. https://doi.org/10.5090/jcs.22.094

Mi Hee Lim, M.D., Hyung Gon Je, M.D., Ph.D., Min Ho Ju, M.D., Ji Hye Lee, R.N., Hye Rim Oh, R.N., Ye Ri Kim, R.N.. Korean J Thorac Cardiovasc Surg 2019;52:385-91. https://doi.org/10.5090/kjtcs.2019.52.6.385

Lim JH, et al. Int J Heart Fail. 2023 Apr;5:e11. https://doi.org/10.36628/ijhf.2023.0013

Korean Circulation Journal 대한심장학회지 순환기 Lee SY, et al. Korean Circ J. 2023 Mar;53:e17. https://doi.org/10.4070/kcj.2022.0197

Background: Minimally invasive procedures are increasingly implemented in aortic valve replacement (AVR) surgeries to minimize surgical trauma and achieve early patient recovery. We aimed to compare between short- and mid-term outcomes for isolated AVR using the representative minimally invasive approaches of right anterior mini-thoracotomy (RAMT) and partial upper sternotomy [J-sternotomy (JS)]. Methods: Patients (n=832) who had undergone surgical AVR between March 2009 and September 2022 were included. We retrospectively examined and compared data from these two minimally invasive approaches, and performed propensity score matching to account for differences in patient baseline characteristics. Early outcomes and late mortality were compared between the matched groups. Results: After applying exclusion criteria, the study comprised 315 patients who underwent RAMT and 92 who underwent JS. Patients who underwent JS had more comorbidities, compared with those who underwent RAMT. Propensity score matching of 16 variables yielded similar groups for comparison (n=90). Thirty-day mortality was similar between the two groups (0% vs. 1%, respectively; P>0.99). In the RAMT group, the rate of on-table extubation was significantly higher (P<0.001), whereas the blood transfusion rate was lower and length of stay was shorter, compared with the JS group. The 5-year survival rate was higher in the RAMT group than in the JS group (95.0% vs. 85.6%, respectively; P=0.03). Conclusions: AVR via RAMT was associated with improved early clinical outcomes, shorter length of stay, and increased survival, compared with JS. Despite the technical challenges associated with RAMT, this procedure can be considered a primary strategy for isolated AVR.

Background: Recognizing the natural progression of the remaining valve disease following the intervention of a single valve is crucial in multiple rheumatic valvular diseases as often encountered in clinical practice. We aimed to investigate whether performing mitral valve (MV) intervention alone for multiple rheumatic MV and aortic valve (AV) disease is safe. Hypothesis: Rheumatic AV disease progresses slowly and severity does not differ significantly after MV intervention. Methods: We retrospectively investigated the progression of AV disease with rheumatic changes following MV intervention in a single tertiary center. Among 890 patients initially screened, 76 patients met the criteria for assessment. Results: Six patients fell under severe aortic stenosis (AS) definition‐wisely and four of them were classified as low‐flow low‐gradient severe AS despite normal ejection fraction. Eventually, four patients were found to have true‐severe AS at a median follow‐up period of four years (mean 5.8 years) and only one of them underwent AV surgery for severe AS per se. None of the patients with aortic regurgitation deteriorated to severe. Conclusions: Only a small portion of rheumatic AV involvement progresses to severe AS after MV intervention, and performing MV intervention for severe mitral stenosis or mitral regurgitation in patients with concurrent mild or moderate AS or aortic regurgitation due to rheumatic changes is reasonable.