Versatility of hemisternotomy for cardiac surgery

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Thoracic Surgery

Background:

• Hemisternotomy is a less invasive surgical approach, often limited to aortic valve disease.
• This study compares outcomes of hemisternotomy versus full sternotomy for various cardiac surgical interventions.

Purpose of the Study:

• To evaluate the safety and efficacy of hemisternotomy for cardiac surgery.
• To compare in-hospital and post-discharge outcomes between hemisternotomy and full sternotomy.
• To assess long-term cardiac morbidity and survival rates.

Main Methods:

• Propensity score matching (1:2) of hemisternotomy (Hemi) to full sternotomy (Full) valve cases.
• In-hospital composite outcome (COMP) included mortality, stroke, infection, sepsis, or reoperation.
• Provincial databases tracked long-term mortality and cardiac readmissions.

Main Results:

• 65 Hemi cases were matched with 130 Full cases for valve surgery analysis.
• In-hospital COMP rates were similar (Hemi=4.6%, Full=8.5%, p=0.39), with low mortality (1.0%).
• Hemisternotomy significantly reduced ventilation time (median 4 vs. 6 hours; p=0.002); 2-year survival and cardiac morbidity were comparable.

Conclusions:

• Hemisternotomy is a safe, effective, and versatile alternative for cardiac surgery.
• This study provides the longest cardiac morbidity follow-up for hemisternotomy.
• A definitive morbidity benefit of hemisternotomy over full sternotomy was not conclusively demonstrated.