A comparison of aortic valve replacement via an anterior right minithoracotomy with standard sternotomy: a propensity score analysis of 492 patients

Bowdish, Michael E.; Hui, Dawn S.; Cleveland, Jeanette N.; Mack, Wendy J.; Sinha, Raina; Ranjan, Rupesh; Cohen, Robbin G.; Baker, Craig J.; Cunningham, Mark J.; Barr, Mark L.; Starnes, Vaughn A.

doi:10.1093/ejcts/ezv038

Cited by 68 publications

(70 citation statements)

References 20 publications

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“…Conflicting results have been reported in human surgery about the morbidity after ICT and MS . During MS, the mediastinum is dissected, which is a major source of fluid production even when electrosurgery is used for the dissection . The volume of fluid produced from the pleural space significantly reduced over time in both groups.…”

Section: Discussionmentioning

confidence: 95%

“…The surgical approach is selected based on the intended procedure, the need for exploration of the pleural space, and clinician preference . In man, current trends in thoracic surgery aim toward less invasive approaches than MS, such as a recent description of a mini thoracotomy for various surgical procedures . However, conflicting results have been published, with some reports of lower morbidity with ICT vs MS, some finding no significant difference, and others raising concerns over increased surgical complexity with mini thoracotomies …”

Section: Introductionmentioning

confidence: 99%

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Median sternotomy versus intercostal thoracotomy for lung lobectomy: A comparison of short‐term outcome in 134 dogs

Bleakley

Phipps²,

Petrovsky³

et al. 2017

Veterinary Surgery

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Objective: To compare short-term outcomes between dogs undergoing lung lobectomy via median sternotomy (MS) or intercostal thoracotomy (ICT).Study design: Retrospective case control study.Methods: Medical records of dogs that underwent lung lobectomy via MS or ICT at a single institution were reviewed for demographics, intraoperative findings, and postoperative management and outcomes. Dogs with pleural effusion, pneumonia, migrating foreign body, lung abscess, spontaneous pneumothorax, or lung lobe torsion were excluded. Short-term outcome factors up were compared up to the time of death, euthanasia, or discharge from the hospital.Results: One hundred and thirty-four dogs met the inclusion criteria. Forty-one (31%) dogs underwent MS and 93 dogs (69%) underwent ICT. Fluid production from the chest tube (P 5 .0061), alveolar arterial pressure gradient (P 5 .0001), and complications requiring intervention (P 5 .0245) were more common in the MS group than the ICT group. Pain management and all other short-term outcome factors did not differ between procedures. Five dogs from the MS group and 4 from the ICT group were euthanized in the postoperative period (P 5 .0925). Conclusion:In a surgical procedure that does not preclude either approach, ICT may be more desirable than MS in terms of postoperative pain, oxygenation, and complications. However, since no other short-term measure of outcome differed, we can state that both MS and ICT are well tolerated by dogs.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Median sternotomy versus intercostal thoracotomy for lung lobectomy: A comparison of short‐term outcome in 134 dogs

Bleakley

Phipps²,

Petrovsky³

et al. 2017

Veterinary Surgery

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show abstract

“…Minimal invasive AVR has several advantages such as shorter length of stay [1,2,3,5,6,8] shorter duration of ventilation [1,2,6,8], decreased time until return to full activity [2], improved cosmetics [4,8,10], decreased rate of postoperative renal failure [5] and less postoperative pain [8] compared with conventional AVR. A recent meta-analysis found no significant difference between AVR and MAVR for postoperative atrial fibrillation, myocardial infarctions, pneumonia, pneumothorax, sternal/wound infections or mortality rate [3].…”

Section: M-avrmentioning

confidence: 99%

“…Compared to conventional sternotomy for aortic valve replacement (AVR), M-AVR diminishes postoperative ventilation time, reduces pain, hospital length of stay, time until return to full activity, and decreases use of blood products [1][2][3][4][5][6][7][8][9][10].Although M-AVR has a mortality rate comparable to conventional AVR [1][2][3][4][5][6][7][8], one of the main obstacles of M-AVR is the increased cardiopulmonary bypass (CPB) and aortic cross-clamping time [9,10].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Retrograde Cardioplegia in Minimal Access Aortic Valve Replacement Reduces Aortic Cross-Clamping Time Significantly

2017

ARC Journal of Anesthesiology

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“…There are several sternum-sparing approaches, such as the anterior thoracotomy, [3,4] lateral thoracotomy [5] and right parasternotomy.…”

Section: Introductionmentioning

confidence: 99%

Modified parasternal approach is a good alternative for aortic valve surgery

Chiu¹

2017

MIS

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Aim: Cardiac surgery, as with other surgical specialties, has moved toward minimally invasive procedures. Currently, since the cardiopulmonary bypass machine remains necessary for most cardiac surgery procedures, efforts have focused on decreasing surgical trauma by limiting vascular access sites and any unnecessary dissection. This study presents the authors' approach for less invasive valve surgery, which aimed to avoid a conventional midline sternotomy and reducing the length of incision. Methods: For patients with aortic valve involvement, parasternal approach was the primary choice. A longitudinal 5-6 cm incision was made one fingerbreadth lateral to the sternal border. The 3rd rib was cut at the chondrosternal junction and bent into the right pleural cavity. After either central aortic or peripheral cannulation, all procedures were completed under surgeon's direct vision and conventional instruments. The rib was reduced into position with a wire to offer stability and eliminate postoperative chest deformity. Results: The authors' experience of more than 500 cases with the minimally invasive approach showed that bypass time and ischemic time for parasternal valve surgery were compatible with to a full-sternotomy approach. In this series, postoperative ventilation Prof. Kuan-Ming Chiu, Vice President in Far Eastern Memorial Hospital (FEMH) and Chief of Cardiovascular Center, Taiwan. He is the Council member of the Thoracic and Cardiovascular Surgeons of Asia (ATCSA), and also serves as the Board member of several societies in Taiwan. Dr. Chiu has performed more than 5,000 cardiac operations, including over 3,000 CABG, more than 1,500 valve surgeries, and 54 heart transplants. The core competencies of his team at FEMH are in off-pump coronary artery bypass (OPCAB) and minimally invasive cardiac surgery (MICS). In August 2010, Dr. Chiu and his team initiated the Da Vinci cardiac surgery procedures and performed 52 such operations in past years. FEMH is considered a leader in endoscopic vessel harvest (EVH) procedures (more than 2,100 cases of EVH experience, including 130 endoscopic radial artery harvests) and is also a premier training center in Asia. Several foreign cardiac surgeons have been to FEMH for EVH and MICS training. More than 85% of the isolated CABG procedures he performed were OPCAB. More than 85% of valve procedures at FEMH are performed via the sternum-sparing approach (MICS). Dr. Chiu has been invited for oral presentations and live demonstrations of his OPCAB and sternum-sparing MICS techniques in Japan, China, Hong Kong, Macau, Vietnam, Malaysia, Singapore, India, Philippines and Korea. His expertise includes endoscopic mitral valve surgery, parasternal aortic valve (multivalve) surgery, and sternum sparing coronary artery bypass.

show abstract

A comparison of aortic valve replacement via an anterior right minithoracotomy with standard sternotomy: a propensity score analysis of 492 patients

Cited by 68 publications

References 20 publications

Median sternotomy versus intercostal thoracotomy for lung lobectomy: A comparison of short‐term outcome in 134 dogs

Median sternotomy versus intercostal thoracotomy for lung lobectomy: A comparison of short‐term outcome in 134 dogs

Percutaneous Retrograde Cardioplegia in Minimal Access Aortic Valve Replacement Reduces Aortic Cross-Clamping Time Significantly

Modified parasternal approach is a good alternative for aortic valve surgery

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