Full Sternotomy, Hemisternotomy, and Minithoracotomy for Aortic Valve Surgery: Is There a Difference?

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Minimally Invasive Surgery

Background:

• Aortic valve replacement (AVR) can be performed using various surgical approaches.
• Understanding the comparative outcomes and mortality rates of these approaches is crucial for patient care.
• Predictors influencing the choice of AVR technique require identification.

Purpose of the Study:

• To compare perioperative results and mortality rates across different aortic valve replacement (AVR) surgical approaches.
• To identify independent predictors associated with in-hospital mortality following AVR.
• To evaluate the efficacy and safety of minimal-access AVR compared to conventional sternotomy.

Main Methods:

• Retrospective data collection from patients undergoing AVR.
• Propensity score matching to adjust for baseline characteristic differences between surgical groups.
• Logistic regression analysis to identify predictors of in-hospital mortality.

Main Results:

• Right anterior minithoracotomy demonstrated shorter cardiopulmonary bypass and cross-clamp times compared to sternotomy and partial upper hemisternotomy.
• No significant difference in in-hospital mortality was observed between the approaches.
• Renal failure, extracardiac arteriopathy, and reduced left ventricular ejection fraction were independent predictors of in-hospital mortality.

Conclusions:

• Minimal-access isolated aortic valve surgery is a reproducible, safe, and effective procedure.
• Outcomes and operating times for minimal-access AVR are comparable to conventional sternotomy.
• The study identified key risk factors impacting mortality in AVR patients.