Ministernotomy for aortic valve replacement: a study of the preliminary experience

The aim of the study was to evaluate the technical feasibility and the postoperative course of aortic valve replacement through a ministernotomy.

The Montreal Heart Institute and the Hôpital Lariboisière, Paris, France.

A case series from 2 institutions.

Fifty-one patients who underwent aortic valve replacement through a ministernotomy. The sternal incision was started at the level of the sternal notch extending down to the third or fourth intercostal space with a transverse section of the sternum at this level on both sides or limited to the right side (inverted T or L incision). Thirty-nine patients had aortic stenoses, 6 patients were operated for aortic insufficiency and 6 had mixed disease. The mean (and standard deviation) preoperative left ventricular ejection fraction was 0.56 (0.17).

Cardiac bypass time, complications and outcome.

The patients received Carbomedics and St. Jude mechanical valves, Hancock and Carpentier-Edwards bioprostheses. Thirty-eight patients were administered antegrade and retrograde cardioplegia, 10 patients antegrade and 3 retrograde blood cardioplegia only. The mean (and standard error) cardiopulmonary bypass time and aortic cross-clamp time were 104 (38) minutes and 72 (16) minutes respectively. Two patients (4%) died and 2 patients (4%) showed evidence of a stroke after the procedure. Hospital stay averaged 8 (5) days.

We conclude that aortic valve replacement can be done through a ministernotomy approach with perioperative results similar to those obtained through a conventional sternotomy.