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Prospective comparison between total sternotomy and ministernotomy for aortic valve replacement.
Fadi Farhat1, Zhiqian Lu, Mathilde Lefevre
1Department of Cardiac Surgery, Louis Pradel Hospital, Claude Bernard University, BP Lyon-Monchat, 69394 Lyon cedex 03, France.
Journal of Cardiac Surgery
|September 17, 2003
Summary
Ministernotomy (MS) is a less invasive alternative to total sternotomy (TS) for aortic valve replacement. While MS requires more surgical time, it offers comparable safety and effectiveness, with reduced intensive care stays, though cosmetic benefits are its primary advantage.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Aortic valve replacement is a common cardiac procedure.
- Ministernotomy (MS) presents an alternative surgical approach to traditional total sternotomy (TS).
- Comparative data on the outcomes and adverse effects of MS versus TS in aortic valve replacement are valuable for surgical decision-making.
Purpose of the Study:
- To prospectively compare the results and adverse effects of ministernotomy (MS) versus total sternotomy (TS) in patients undergoing aortic valve replacement.
- To evaluate the technical demands, safety, and effectiveness of the MS approach in aortic valve surgery.
Main Methods:
- A prospective study involving 100 patients undergoing aortic valve replacement between January and December 2000.
- Patients were divided into two groups of 50: one undergoing MS and the other TS, with all procedures performed by a single senior surgeon in each group.
- Data collected included operative times, cross-clamping and bypass durations, intensive care unit stay, intubation time, bleeding, reinterventions, complications, and mortality.
Main Results:
- Ministernotomy (MS) required significantly longer aortic cross-clamping (66 +/- 14 min vs 48 +/- 9 min) and cardiopulmonary bypass times (88 +/- 18 min vs 69 +/- 10 min, p < 0.01) compared to total sternotomy (TS).
- Mean intensive care unit stay was significantly reduced in the MS group (1.7 +/- 1.6 days vs 2.6 +/- 6 days, p < 0.05).
- Intervention times, intubation duration, 24-hour bleeding, reintervention for hemostasis, rhythmic complications, and 1-month mortality were comparable between the MS and TS groups.
Conclusions:
- Ministernotomy (MS) is technically more demanding and requires more operative time in aortic valve surgery compared to total sternotomy (TS).
- MS is as safe and effective as TS, with comparable clinical outcomes and complication rates.
- The primary benefits of MS in aortic valve surgery, beyond potential cosmetic advantages, require further definition and investigation.