Ministernotomy versus median sternotomy for aortic valve replacement: a prospective, randomized study

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Minimally Invasive Procedures

Background:

• Minimally invasive aortic valve replacement (MIAVR) is theorized to reduce surgical trauma, pain, blood loss, and hospital stay compared to traditional methods.
• A prospective, randomized study was conducted to validate these purported advantages.

Purpose of the Study:

• To compare the outcomes of MIAVR using ministernotomy versus traditional median sternotomy for isolated, elective aortic valve replacement.
• To evaluate differences in postoperative pain, pulmonary function, and length of hospital stay between the two surgical approaches.

Main Methods:

• Forty patients were randomized into two equal groups: ministernotomy (Group M) and median sternotomy (Group S).
• An identical anesthetic and surgical protocol was followed for both groups.
• Pain, pulmonary function, and other clinical outcomes were assessed and compared.

Main Results:

• While mortality was similar (two deaths per group), Group M experienced significantly longer cross-clamp times (70 min vs. 51 min).
• No significant differences were observed in pump time, extubation, chest drainage, transfusion needs, pain scores, length of stay, or cosmetic results.
• Pulmonary function tests showed comparable decreases in forced vital capacity and forced expiratory volume in 1 second for both groups.

Conclusions:

• The study failed to demonstrate the theoretical advantages of MIAVR over median sternotomy.
• MIAVR was associated with a longer cross-clamp time compared to the conventional median sternotomy approach.