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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
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Ministernotomy compared with right anterior minithoracotomy for aortic valve surgery
Massimo Bonacchi1, Aleksander Dokollari2, Orlando Parise3
1Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy.
The Journal of Thoracic and Cardiovascular Surgery
|May 17, 2021
Summary
Minimally invasive aortic valve replacement via ministernotomy shows better early and long-term outcomes than minithoracotomy. This approach reduces operative time, hospital stay, and mortality for aortic valve surgery patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Procedures
Background:
- Minimally invasive aortic valve replacement (AVR) utilizes two primary techniques: ministernotomy and right anterior minithoracotomy.
- Comparing the early and long-term outcomes of these two approaches is crucial for optimizing patient care.
Purpose of the Study:
- To compare the early and long-term clinical outcomes of ministernotomy versus right anterior minithoracotomy for minimally invasive aortic valve replacement.
Main Methods:
- A retrospective analysis of 2419 patients undergoing isolated minimally invasive AVR between 1999 and 2019.
- Propensity score matching created comparable groups: 986 patients in the ministernotomy group and 986 in the minithoracotomy group.
Main Results:
- Ministernotomy demonstrated significantly shorter operation times and lower conversion rates to full sternotomy.
- The ministernotomy group had lower 30-day mortality, reduced intensive care unit (ICU) and hospital lengths of stay.
- Minithoracotomy was identified as the strongest independent predictor of early mortality, with significantly better long-term survival in the ministernotomy group.
Conclusions:
- Ministernotomy is associated with improved early and long-term mortality, reduced operative time, shorter hospital stays, and fewer postoperative morbidities.
- The ministernotomy approach offers a superior alternative for minimally invasive aortic valve replacement compared to minithoracotomy.
