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Partial versus full sternotomy for aortic valve replacement.

M F Szwerc1, D H Benckart, R J Wiechmann

  • 1Department of Cardiothoracic Surgery, Allegheny University Hospitals, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.

The Annals of Thoracic Surgery
|January 5, 2000
PubMed
Summary
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Partial upper sternotomy for aortic valve replacement yielded comparable outcomes to median sternotomy. While offering cosmetic benefits, this approach did not significantly reduce pain, hospital stay, or costs.

Area of Science:

  • Cardiovascular Surgery
  • Minimally Invasive Cardiac Surgery

Background:

  • Growing evidence supports smaller incisions for reduced postoperative morbidity.
  • This study investigated the efficacy of partial upper sternotomy in aortic valve replacement (AVR).

Purpose of the Study:

  • To test the hypothesis that partial upper sternotomy improves patient outcomes for AVR compared to traditional median sternotomy.
  • To evaluate the clinical benefits and drawbacks of AVR via partial upper sternotomy.

Main Methods:

  • A prospective comparative study involving 100 patients undergoing AVR.
  • Group I (n=50): Aortic valve surgery via partial upper sternotomy.
  • Group II (n=50): Aortic valve replacement via median sternotomy, with similar baseline characteristics and surgical techniques (central cannulation, antegrade/retrograde cardioplegia).

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Main Results:

  • Mortality rates were similar between groups (1 death each).
  • No significant differences observed in aortic occlusion time, drainage, transfusion needs, narcotic use, length of stay, or cost.
  • Partial sternotomy group showed increased incidence of pleural/pericardial effusions (18.4% vs 3.9%) and higher need for postoperative inotropic support (38.7% vs 19.6%).

Conclusions:

  • Aortic valve replacement is feasible via partial upper sternotomy with comparable results to full sternotomy.
  • Partial upper sternotomy provides cosmetic advantages but does not significantly decrease postoperative pain, hospital stay, or healthcare costs.
  • Increased rates of effusions and need for inotropic support warrant consideration in partial sternotomy procedures.