J-Shaped Upper Mini-Sternotomy Versus Full Sternotomy for Aortic Valve Replacement: A Comparative Study

Abstract

<jats:p>Background: This study aims to compare the characteristics between patients who underwent aortic valve replacement (AVR) through a J-shaped upper mini-sternotomy (UMS) and patients who underwent full sternotomy (FS) in the basis of clinical care and hospital outcomes. Methods: A retrospective, cross-sectional study was conducted on adult patients who were subjected to AVR by UMS from 2014 to 2017, compared with a historical control of patients who had undergone UMS by FS from 2011 to 2014. Patients, who received combined valve replacement or aortic surgery, as well as heart valve reinterventions due to endocarditis, were excluded. Sociodemographic characteristics, medical history, hospital and intensive care stay, blood transfusions, complications, and mortality of both procedures were compared. Results: There were 57 patients under UMS and 99 patients under FS included in this study. The median age was 67 years, and 56.77% of the patients were male. No differences were observed in the past medical history and the type of valve implanted between the groups. During surgery, patients under UMS received a lower percentage of red blood cell and platelet transfusions compared with FS. However, UMS had a higher percentage of cryoprecipitate transfusion. Intensive care stay was shorter in UMS compared with FS (three days; interquartile range [IQR], 2–4; and four days; IQR, 2–6, respectively) without differences in overall hospital stay, postoperative complications, in-hospital mortality, and 30-day mortality. Conclusions: The J-shaped upper mini-sternotomy is a feasible surgical technique that does not increase in-hospital or 30-day mortality, neither hospital stay nor infectious complications.</jats:p>

Aortic Valve Replacement: Is Minimally Invasive Really Better? A Contemporary Systematic Review and Meta-Analysis

“…30-day mortality ranged from 0.0 to 5.2%, 0.0 to 2.0%, and 0.0 to 2.8% in full sternotomy, ministernotomy, and right anterior thoracotomy, respectively. 10,12,13,16,20,24,26,27,29,30,40,43,46,52,54,55,57 Aggregate analysis trended towards favouring ministernotomy over full sternotomy (OR 1.42; 95% CI, 0.99–2.05; Chi2 = 5.58; I 2 = 0%; P = 0.06). Right anterior thoracotomy significantly outperformed full sternotomy (OR 3.45; 95% CI, 1.42–8.37; Chi2 = 0.11; I 2 = 0%; P = 0.006) (Figure 3D–E).…”

“…Forty-five studies met the inclusion criteria and included a total of 148,606 patients. 10–33,39–58 Data collection ranged from 1999 to 2020. Included articles consisted of retrospective studies, prospective studies, and randomized controlled trials.…”

“…In-hospital mortality ranged from 0.0-11.5% in full sternotomy, 0.0-12.2% in ministernotomy, and 0.0-2% in right anterior thoracotomy. 11,[14][15][16][17][18][19][21][22][23]25,[31][32][33][39][40][41][42]44,47,[49][50][51]53,54,58 Pooled estimates favoured ministernotomy over full sternotomy (OR 1.14; 95% CI, 1.02-1.27; Chi2 = 15.35; I 2 = 15%; P = 0.02). There was no difference between full sternotomy and right anterior thoracotomy (OR 1.06; 95% CI, 0.89-1.27; Chi2 = 1.59; I 2 = 0%; P = 0.50), or ministernotomy and right anterior thoracotomy (OR 0.96; 95% CI, 0.79-1.17; Chi 2 =1.36; I 2 = 0%; P = 0.69)(Figure 3A-C).…”

Mini‐sternotomy versus full sternotomy for isolated aortic valve replacement: A single‐center experience

“…The widespread adoption of the MS has been somewhat controversial. MS has been proposed to result in reduced blood loss, early postoperative recovery, reduced risk of sternal wound infection, improved cosmesis, reduced pain, decreased postoperative morbidity, and improved patient satisfaction and has therefore been recommended by numerous authors and surgeons 3,4,9–12,15–22 . However, MS AVR has been associated with several disadvantages including inferior exposure, difficulty de‐airing the heart at the end of the case, prolonged operative, cardiopulmonary bypass (CPB), and aortic cross‐clamp times 3,4,9–12,15,17,18,20–23 .…”

“…MS has been proposed to result in reduced blood loss, early postoperative recovery, reduced risk of sternal wound infection, improved cosmesis, reduced pain, decreased postoperative morbidity, and improved patient satisfaction and has therefore been recommended by numerous authors and surgeons. 3,4,[9][10][11][12][15][16][17][18][19][20][21][22] However, MS AVR has been associated with several disadvantages including inferior exposure, difficulty de-airing the heart at the end of the case, prolonged operative, cardiopulmonary bypass (CPB), and aortic cross-clamp times. 3,4,[9][10][11][12]15,17,18,[20][21][22][23] The reported disadvantages of MS AVR have deterred some surgeons from adopting the MS over the conventional sternotomy for AVR, particularly in high-risk populations.…”