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Published on: December 11, 2017
Comparison of right ventricular function after ministernotomy and full sternotomy aortic valve replacement: a
Magnus Dalén1,2, Cristina Oliveira Da Silva3, Ulrik Sartipy1,2
1Department of Cardiac Surgery, Karolinska University Hospital, Stockholm, Sweden.
Minimally invasive aortic valve replacement preserves right ventricular (RV) function better than full sternotomy. While both procedures impair RV function, ministernotomy shows less reduction in RV long-axis function post-surgery.
Area of Science:
- Cardiac Surgery
- Cardiology
- Thoracic Surgery
Background:
- Right ventricular (RV) function impairment is a known complication after cardiac surgery, potentially linked to pericardial opening.
- Minimally invasive aortic valve replacement involves only a partial pericardial incision, suggesting potential benefits for RV function.
Purpose of the Study:
- To compare right ventricular (RV) function after minimally invasive ministernotomy versus full sternotomy in patients undergoing aortic valve replacement.
- To evaluate the impact of surgical approach on RV systolic excursion, Doppler velocity, and fractional area change.
Main Methods:
- A randomized trial involving 40 adults undergoing aortic valve replacement.
- Comparison of RV function using tricuspid annular plane systolic excursion, RV pulsed-wave tissue Doppler velocity, and RV fractional area change on postoperative Days 4 and 40.
- Surgical approaches included ministernotomy and full sternotomy.
Main Results:
- Right ventricular (RV) long-axis function (tricuspid annular plane systolic excursion) decreased postoperatively in both groups but was significantly higher in the ministernotomy group.
- Pulsed-wave tissue Doppler RV velocity decreased significantly after full sternotomy but showed no significant decrease after ministernotomy.
- Global RV function (fractional area change) was equally impaired in both ministernotomy and full sternotomy groups postoperatively.
Conclusions:
- Right ventricular (RV) long-axis function is reduced after both ministernotomy and full sternotomy aortic valve replacement.
- The reduction in RV long-axis function is more pronounced following a full sternotomy approach.
- Overall global RV function impairment was similar between the two surgical methods.
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