Ministernotomy or sternotomy in isolated aortic valve replacement? Early results

Abstract

IntroductionAortic valve replacement (AVR) is the gold standard in treating symptomatic aortic valve defects. To improve the healing process and limit the trauma, the minimally invasive approach was introduced.AimTo compare the peri- and post-operative results of aortic valve replacement performed via conventional full sternotomy (con-AVR) and of AVR performed via partial upper sternotomy (mini-AVR).Material and methodsThe total study population was divided into 2 demographically homogeneous groups: mini-AVR (n = 74) and con-AVR (n = 76). There were no statistically significant differences in preoperative echocardiography.ResultsAortic cross-clamp time and cardiopulmonary bypass time were significantly longer in the mini-AVR group. Shorter mechanical ventilation time, hospital stay and lower postoperative drainage were observed in the mini-AVR group (p < 0.05). Biological prostheses were more frequently implanted in the mini-AVR group (p < 0.05). Patients from the mini-AVR group reported less postoperative pain. No significant differences were found in the diameter of the implanted aortic prosthesis, the amount of inotropic agents and painkillers, postoperative left ventricular ejection fraction (LVEF), medium and maximum transvalvular gradient or the number of transfused blood units. There were no differences in the frequency of postoperative complications such as mortality, stroke, atrial fibrillation, renal failure, wound infection, sternal instability, or the need for rethoracotomy.ConclusionsMinisternotomy for AVR is a safe method and does not increase morbidity and mortality. It significantly reduces post-operative blood loss and shortens hospital stay. Ministernotomy can be successfully used as an alternative method to sternotomy.

Minimally invasive aortic root surgery: Midterm results in a 2‐year follow‐up

“…There are different types of partial sternotomy 5‐7 In the mostly common J‐shaped PUS, the upper part of sternum is incised down to the third or fourth right intercostal space. The benefit of this MIS approach for aortic valve surgery has been proved in numerous practical studies compared with the standard and usual access with FMS 8‐11 It reduces surgical trauma, which leads to less postoperative pain and enhanced recovery of the respiratory function. The preserved lower part of the sternum, as an intact part of the native chest architecture, increases sternal stability, and reduces the risk of sternal wound infection.…”

“…Since the 1990s, minimally invasive surgery (MIS) through a partial upper sternotomy (PUS) has been used as an alternative access way in the surgical treatment of aortic valve and aortic diseases 3 . In the last years, the pros and cons of this access were widely discussed 3‐9 Nowadays conventional aortic valve replacement is performed in approximately 10% of cases as an MIS procedure via PUS, but only a few studies report an MIS approach for more demanding procedures on the aortic root 10‐12 the ascending aorta 13 or the aortic arch 14 . In this study we present our clinical experience in treating aortic root aneurysm and localized chronic aortic root dissection through minimally invasive PUS.…”

Surgery of ascending aorta with complex procedures for aortic dissection through upper mini-sternotomy versus conventional sternotomy

“…Different minimally invasive approaches have been reported for cardiac surgery [7,8]. Widespread consensus has been reached regarding the efficacy of upper J ministernotomy for the treatment of aortic disease [2,9,10]. The indication for surgery, initially restricted only to selected patients, is now extended to those undergoing more complex surgeries, including surgeries involving the aortic root and ascending aorta as well as redo operations.…”

Results of correction of aortic valve defects using small‑diameter «BioLAB» xenopericardial prosthesis in old patients

“…Трем пациентам с ожирением в нашем исследовании была выполнена J-образная мини-стернотомия, чтобы избежать развития дыхательной недостаточности и раневых осложнений в послеоперационном периоде. Известно, что мини-стернотомия при изолированном протезировании аортального клапана является безопасной процедурой, она снижает риск кровопотери, уменьшает послеоперационный койко/день, пациенты меньше страдают от боли в раннем послеоперационном периоде [18,19]. Nobuyuki Furukawa et al считают, что основными преимуществами мини-стернотомии нужно считать уменьшение послеоперационного болевого синдрома, улучшение дыхательной функции, а также более раннее возвращение к повседневной деятельности, что значительно важнее для пациентов пожилого возраста, чем косметический эффект процедуры [20].…”

“…С января 2011 года по август 2018 года в отделении неотложной хирургии приобретенных пороков сердца было имплантировано 65 каркасных ксеноперикардиальных протезов «БиоЛАБ» малых (18,20) размеров в позицию аортального клапана, одной пациентке протез 20-го размера был имплантирован дважды, второй раз в связи с перенесенным поздним протезным эндокардитом. Средний возраст пациентов 75,4 ± 4,1 года (от 65 до 86 лет).…”