Ministernotomy versus full sternotomy aortic valve replacement with a sutureless bioprosthesis: a multicenter study

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Bioprosthetic Valves

Background:

• Aortic valve replacement (AVR) is a critical procedure for severe aortic valve disease.
• Minimally invasive techniques are increasingly explored to improve patient recovery.
• The sutureless Perceval bioprosthesis offers potential advantages in AVR procedures.

Purpose of the Study:

• To compare early postoperative outcomes and 2-year survival after AVR using the sutureless Perceval bioprosthesis.
• To evaluate the safety and reproducibility of ministernotomy versus full sternotomy for this specific bioprosthesis.
• To assess the impact of surgical approach on key operative and survival metrics.

Main Methods:

• A comparative study of 267 patients undergoing isolated AVR with the sutureless Perceval bioprosthesis.
• Procedures were performed via either ministernotomy (189 patients) or full sternotomy (78 patients).
• Propensity score matching was employed to create comparable groups and reduce selection bias.

Main Results:

• No significant differences in in-hospital mortality (1.1% vs. 2.6%) or 2-year survival (92% vs. 91%) between ministernotomy and full sternotomy groups.
• Comparable aortic cross-clamp and cardiopulmonary bypass times were observed between the two surgical approaches.
• While ministernotomy showed higher postoperative gradients, overall early outcomes and survival remained similar post-propensity matching.

Conclusions:

• Minimally invasive AVR with the sutureless Perceval bioprosthesis via ministernotomy is a safe and reproducible procedure.
• The ministernotomy approach does not lead to prolonged aortic cross-clamp or cardiopulmonary bypass times compared to full sternotomy.
• Early postoperative outcomes and long-term survival are comparable between ministernotomy and full sternotomy for AVR with this bioprosthesis.