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Comparison of minithoracotomy and conventional sternotomy approaches for valve surgery
Cyrille de Vaumas1, Ivan Philip, Georges Daccache
1Service d'Anesthésie Réanimation Chirurgicale, Hôspital Bichat-Claude Bernard, Paris, France. cyrille.de-vaumas@bch.ap-hop-paris.fr
Objective:
To compare patients undergoing valve surgery through a minithoracotomy approach with a matched group undergoing conventional valve surgery.
Design:
Control study.
Setting:
University hospital, single center.
Participants:
Forty-one consecutive patients scheduled for valve surgery by minithoracotomy approach were matched with a similar group of patients operated on by the sternotomy approach.
Interventions:
Criteria for matching included type of valve procedure (aortic valve replacement or mitral valve repair), age, surgeons, and left ventricular function. Two surgeons performed the surgical procedures. Perioperative care was standardized for all patients. Operative and postoperative data were recorded.
Measurements And Main Results:
The 41 pairs of patients were correctly matched, except for left ventricular function (n = 1). Twenty patients underwent mitral valve repair and 62 aortic valve replacement. Preoperative demographic data and clinical characteristics were similar in both groups. Cardiopulmonary bypass, aortic clamping, and surgery times were longer in the minithoracotomy group (p < 0.05). In 3 patients, the minithoracotomy approach had to be converted into a sternotomy during the surgical procedure for better visualization. Minithoracotomy patients had significantly increased postoperative total blood loss (p < 0.05). No difference was found between the groups for extubation time and intensive care or in-hospital lengths of stay.
Conclusion:
These results suggest that valve surgery is feasible in many cases through minithoracotomy. Nevertheless, this approach increases surgical complexity and in this comparative study no significant benefit was shown.