Minimal vs median sternotomy for aortic valve replacement

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Minimally Invasive Procedures

Background:

• Conventional sternotomy for aortic valve replacement (AVR) involves a large incision and significant patient recovery time.
• Minimally invasive surgical techniques are increasingly explored to improve patient outcomes and reduce surgical trauma.

Purpose of the Study:

• To compare postoperative outcomes between aortic valve replacement using ministernotomy versus conventional sternotomy.
• To evaluate differences in pain, pulmonary function, blood loss, and hospital stay between the two surgical approaches.

Main Methods:

• A randomized controlled trial involving 60 patients undergoing AVR.
• Patients were divided into two groups: conventional full sternotomy (n=30) and ministernotomy (n=30).
• Postoperative outcomes including pain, pulmonary function, drainage, blood transfusion, ventilation time, and hospital stay were assessed.

Main Results:

• The ministernotomy group had significantly shorter skin incisions (7.17 cm vs 24.50 cm) and less mediastinal drainage (233 mL vs 590 mL in 24 hours).
• Patients undergoing ministernotomy experienced less pain (93.3% minimal pain vs 96.7% severe pain), required fewer blood transfusions, and had shorter ventilation times.
• Hospital stay was markedly reduced in the ministernotomy group (8.0 days vs 17.7 days).

Conclusions:

• Ministernotomy for aortic valve replacement provides superior cosmetic results, reduced blood loss, and improved sternal stability.
• This approach leads to better respiratory function, earlier extubation, and significantly shorter hospital discharge times compared to conventional sternotomy.
• Minimally invasive ministernotomy is a favorable alternative for aortic valve replacement, enhancing patient recovery and overall surgical experience.