Patients undergoing minimally invasive aortic valve replacement (MIAVR) using two facilitating technologies had several significant benefits when compared with MIAVR patients whose surgeries did not include facilitating technologies, according to a new study authored by several clinicians from Lankenau Medical Center, part of Main Line Health.
The two facilitating technologies (FT) were the Cor-Knot titanium fastener and Custodiol-HTK cardioplegia. Cor-Knot is an automated suture fastener that secures the prosthetic valve to the aortic annulus in lieu of hand-tied knots and provides controlled reproducible knot tying in a limited surgical field. Custodiol-HTK is a cardioplegic solution that safely provides up to two hours of myocardial protection in a single dose.
The researchers reviewed records of all adults who underwent MIAVR at Lankenau Medical Center from 2008 to 2016. During the study period, 299 patients underwent MIAVR. Of those, 172 patients had surgery in which FT was used, and 127 patients had no FT. To adjust for differences in baseline characteristics, a total of 94 matched pairs of FT and no FT patients were selected for analysis.
In reviewing the records of the two cohorts, the researchers found that surgeries that included FT had statistically significant reductions in cardiopulmonary bypass and aortic cross-clamp times. Patients who had FT treatment had fewer red blood cell and cryoprecipitate transfusions. Fewer patients had renal failure or required prolonged mechanical ventilator support. And hospital stays were markedly shorter. No differences in pre- or postoperative ejection fraction levels, stroke, sepsis, pneumonia, pneumothorax, pulmonary embolism or atrial fibrillation were detected.
The authors, whose manuscript “Facilitating technologies in minimally invasive aortic valve replacement: a propensity score analysis” was published in a recent edition of the biomedical journal Interactive Cardiovascular and Thoracic Surgery, wrote that they believe the implementation of these two facilitating technologies resulted in a synergistic effect that helped facilitate the MIAVR procedure.
Konstadinos A. Plestis, MD, system chief of cardiothoracic and vascular surgery at Lankenau Heart Institute, and clinical professor at the Lankenau Institute for Medical Research, was the lead author. “By releasing the results of our study, we hope to show the use of facilitating technologies can improve patient outcomes and thus may lead to a wider adoption of MIAVR within the cardiac surgical community,” said Dr. Plestis.
Other Main Line Health clinicians and researchers who participated in the study included Scott Goldman, MD; Matthew Thomas, MD; Oleg Orlov, MD; Vishal N. Shah, DO; Cinthia Orlov, MD; and Georgia Panagopoulos, PhD.
About Main Line Health
Founded in 1985, Main Line Health is a not-for-profit health system serving portions of Philadelphia and its western suburbs. Main Line Health’s commitment—to deliver advanced medicine to treat and cure disease while also playing an important role in prevention and disease management as well as training physicians and other health care providers—reflects our intent to keep our community and ourselves well ahead. A team of more than 10,000 employees and 2,000 physicians care for patients throughout the Main Line Health system.
At Main Line Health’s core are four of the region’s most respected acute care hospitals—Lankenau Medical Center, Bryn Mawr Hospital, Paoli Hospital and Riddle Hospital—as well as one of the nation’s recognized facilities for rehabilitative medicine, Bryn Mawr Rehabilitation Hospital.
The Main Line Health system also includes Mirmont Treatment Center for drug and alcohol recovery; Main Line Health HomeCare & Hospice, which includes skilled home health care, hospice and home infusion services; Main Line Health Centers, primary and specialty care, lab and radiology, and other outpatient services located in Broomall, Collegeville, Concordville, Exton and Newtown Square; Lankenau Institute for Medical Research, a biomedical research organization; and Main Line HealthCare, one of the region’s largest multispecialty physician networks.
Main Line Health is the recipient of numerous awards for quality care and service, including System Magnet® designation, the nation’s highest distinction for nursing excellence, the Mid-Atlantic Alliance for Performance Excellence (MAAPE) Excellence Award, and recognition as among the nation’s best employers by Forbes magazine. Main Line Health is committed to creating an environment of diversity, respect and inclusion and has proudly embraced the American Hospital Association’s #123forEquity Pledge to Act to eliminate disparities in care. We are dedicated to advancing patient-centered care, education and research to help our community stay healthy.
About Lankenau Medical Center
Lankenau Medical Center, a member of Main Line Health, is recognized as a national leader in advancing new options to diagnose and treat illness, protect against disease and save lives. Located on a 93-acre campus just outside of Philadelphia, Lankenau Medical Center is a 389-bed, not-for-profit teaching hospital that includes one of the nation’s leading cardiovascular centers; the Lankenau Institute for Medical Research, one of the few freestanding hospital-associated research centers in the nation; and the Annenberg Conference Center for Medical Education, that trains over 100 new physicians each year through nationally ranked residency and fellowship programs. Lankenau has received both regional and national recognition for its excellence in providing state-of-the-art, quality care. Lankenau Medical Center has been named among the top 10 hospitals in Pennsylvania and top five in the Philadelphia metro area in U.S. News & World Report’s Best Hospitals 2016–17, and was ranked as high-performing in four specialties: gastroenterology & GI surgery, geriatrics, orthopedics and pulmonology. Lankenau was also ranked as high performing in all nine of the Common Core specialty areas that the publication analyzes, including: abdominal aortic aneurysm repair, aortic valve surgery, COPD, colon cancer surgery, congestive heart failure, heart bypass surgery, hip replacement, knee replacement and lung cancer surgery. Lankenau has achieved The Joint Commission’s Gold Seal of Approval for stroke care and breast cancer care and is one of the nation’s Top Performing Hospitals for heart attack, heart failure, pneumonia and surgical care. Lankenau has also been ranked for multiple years as one of the top 50 cardiovascular hospitals in the nation by Truven Health Analytics. Lankenau has also earned the highest distinction for excellence in nursing care, the American Nurses Credentialing Center Magnet® designation.
About Lankenau Institute for Medical Research
Lankenau Institute for Medical Research (LIMR) is a nonprofit biomedical research institute located on the campus of Lankenau Medical Center and is part of Main Line Health. Founded in 1927, LIMR’s mission is to improve human health and well-being. Faculty and staff are devoted to advancing innovative new approaches to formidable medical challenges, including cancer, cardiovascular disease, gastrointestinal disorders and autoimmune diseases, such as diabetes and arthritis. LIMR’s principal investigators conduct basic, preclinical and translational research, using their findings to explore ways to improve disease detection, diagnosis, treatment and prevention. They are committed to extending the boundaries of human health through technology transfer and training of the next generation of scientists and physicians.