Related Experiment Video
Updated: Mar 27, 2026
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Right miniparasternotomy may be a good minimally invasive alternative to full sternotomy for cardiac valve
Kuan M Chiu1, Robert J Chen, Tzu Y Lin
1Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan - shchu.femh@gmail.com.
Background:
Limited real-world data existed for mini-parasternotomy approach with good sample size in Asian cohorts and most previous studies were eclipsed by case heterogeneity. The goal of this study was to compare safety and quality outcomes of cardiac non-coronary valve operations by mini-parasternotomy and full sternotomy approaches on risk-adjusted basis. METHODS From our hospital database, we retrieved the cases of non-coronary valve operations from 1 January 2005 to 31 December 2012, including re-do, emergent, and combined procedures. Estimated EuroScore-II and propensity score for choosing mini-parasternotomy were adjusted for in the regression models on hospital mortality, complications (pneumonia, stroke, sepsis, etc.), and quality parameters (length of stay, ICU time, ventilator time, etc.). Non-complicated cases, defined as survival to discharge, ventilator use not over one week, and intensive care unit stay not over two weeks, were used for quality parameters.
Results:
There were 283 mini-parasternotomy and 177 full sternotomy cases. EuroScore-II differed significantly (medians 2.1 vs. 4.7, P<0.001). Propensity scores for choosing mini-parasternotomy were higher with lower EuroScore-II (OR=0.91 per 1%, P<0.001), aortic regurgitation (OR=2.3, P=0.005), and aortic non-mitral valve disease (OR=3.9, P<0.001). Adjusted for propensity score and EuroScore-II, mini-parasternotomy group had less pneumonia (OR=0.32, P=0.043), less sepsis (OR=0.31, P=0.045), and shorter non-complicated length of stay (coefficient=-7.2 (day), P<0.001) than full sternotomy group, whereas Kaplan-Meier survival, non-complicated ICU time, non-complicated ventilator time, and 30-day mortality did not differ significantly.
Conclusion:
The propensity-adjusted analysis demonstrated encouraging safety and quality outcomes for mini-parasternotomy valve operation in carefully selected patients.
Insights
The mini-parasternotomy approach for cardiac valve operations shows reduced pneumonia and sepsis rates, with shorter hospital stays compared to full sternotomy. This minimally invasive technique offers comparable survival and mortality outcomes in carefully selected patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Surgery
Background:
- Limited real-world data on mini-parasternotomy in Asian populations.
- Previous studies lacked sufficient sample size and had heterogeneous case mixes.
- Need for risk-adjusted comparison of mini-parasternotomy versus full sternotomy for cardiac valve operations.
Purpose of the Study:
- To compare safety and quality outcomes of cardiac non-coronary valve operations using mini-parasternotomy versus full sternotomy.
- To conduct a risk-adjusted analysis considering EuroScore-II and propensity scores.
- To evaluate hospital mortality, complications, and quality parameters like length of stay.
Main Methods:
- Retrospective analysis of 283 mini-parasternotomy and 177 full sternotomy cases (2005-2012).
- Inclusion of re-do, emergent, and combined procedures.
- Risk adjustment using EuroScore-II and propensity scores in regression models for mortality, complications, and quality metrics.
Main Results:
- Mini-parasternotomy group showed significantly less pneumonia (OR=0.32) and sepsis (OR=0.31).
- Shorter non-complicated length of stay observed in the mini-parasternotomy group (coefficient=-7.2 days).
- No significant differences in survival, ICU time, ventilator time, or 30-day mortality.
Conclusions:
- Mini-parasternotomy demonstrates favorable safety and quality outcomes in carefully selected cardiac valve surgery patients.
- Propensity-adjusted analysis supports the efficacy of the minimally invasive approach.
- Encouraging results suggest mini-parasternotomy as a viable alternative to full sternotomy for specific patient groups.
