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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Ministernotomy versus conventional sternotomy for aortic valve replacement: a systematic review and meta-analysis
Morgan L Brown1, Stephen H McKellar, Thoralf M Sundt
1Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
The Journal of Thoracic and Cardiovascular Surgery
|March 5, 2009
Summary
Minimally invasive aortic valve replacement via ministernotomy is safe, showing no increased mortality compared to full sternotomy. However, objective benefits are limited, necessitating further research into its role in cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
Background:
- Conventional aortic valve replacement (AVR) typically involves a full median sternotomy.
- Less invasive surgical approaches, such as partial upper sternotomy (ministernotomy), have been developed for AVR.
Purpose of the Study:
- To systematically review and meta-analyze studies comparing ministernotomy and full sternotomy for AVR.
- To assess the safety and efficacy of ministernotomy versus conventional sternotomy in AVR.
Main Methods:
- Systematic review and meta-analysis of 26 studies involving 4586 patients undergoing AVR.
- Comparison of outcomes between ministernotomy (2054 patients) and full sternotomy (2532 patients).
Main Results:
- No significant difference in mortality between ministernotomy and full sternotomy (OR 0.71).
- Ministernotomy was associated with longer crossclamp and bypass times.
- Shorter intensive care unit and hospital stays were observed with ministernotomy.
- Reduced ventilation time and less blood loss within 24 hours were noted for ministernotomy.
- The rate of conversion from ministernotomy to full sternotomy was 3.0%.
Conclusions:
- Ministernotomy is a safe approach for AVR, without increasing the risk of death or major complications.
- Objective clinical advantages of ministernotomy over full sternotomy are not definitively established.
- Further well-designed prospective studies are needed to clarify the role of ministernotomy in cardiac surgery.
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