Partial upper re-sternotomy for aortic valve replacement or re-replacement after previous cardiac surgery

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Aortic Valve Surgery

Background:

• Previous cardiac surgery increases complexity and risk for subsequent aortic valve procedures.
• Conventional full re-sternotomy carries significant morbidity.
• Minimally invasive approaches aim to reduce surgical trauma and improve patient outcomes.

Purpose of the Study:

• To evaluate the safety and efficacy of an 'inverted T' partial upper re-sternotomy for aortic valve replacement (AVR) or re-replacement (AVreR) in patients with prior cardiac surgery.
• To refine technical aspects of this minimally invasive approach.
• To report on patient follow-up and outcomes.

Main Methods:

• A series of 34 AVRs or AVreRs were performed using an 'inverted T' partial upper re-sternotomy between November 1996 and December 1999.
• Patients had a median age of 72, with a significant proportion having prior coronary artery bypass grafts (CABG) or valve surgery.
• Follow-up was 100% complete for a median of 19 months.

Main Results:

• No intraoperative or valve-related complications occurred, and no conversion to full re-sternotomy was needed.
• Operative mortality was 5.9% (2/34), with low rates of major complications (25%), bleeding, and need for transfusion.
• Complications included new atrial fibrillation (9%), pacemaker implantation (9%), and deep sternal wound infection (6%).

Conclusions:

• Partial upper re-sternotomy is a safe and effective alternative for AVR and AVreR after previous cardiac surgery.
• This minimally invasive technique is associated with low morbidity and mortality.
• The approach offers substantial benefits compared to conventional full re-sternotomy.