Mini Sternotomy and Mini Thoracotomy for Aortic Valve Replacement: Is There a Difference?

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Minimally Invasive Procedures

Background:

• Minimally invasive valve replacement, particularly for aortic valve replacement (AVR), is gaining acceptance.
• Ministernotomy and minithoracotomy are the primary surgical approaches for minimally invasive AVR.
• Direct comparative data on the superiority of ministernotomy versus minithoracotomy for AVR is limited.

Purpose of the Study:

• To compare the outcomes of ministernotomy versus minithoracotomy approaches for minimally invasive aortic valve replacement.
• To evaluate operative details, mortality, wound cosmetics, and postoperative pain between the two incision types.

Main Methods:

• Retrospective analysis of 260 patients undergoing minimally invasive AVR.
• 132 patients in the ministernotomy group and 128 in the minithoracotomy group.
• Primary endpoints included operative times, mortality, wound cosmesis, and pain scores.

Main Results:

• Ministernotomy (MS) showed significantly shorter cross-clamp and bypass times compared to minithoracotomy (MT).
• Minithoracotomy incisions resulted in significantly shorter wound lengths, offering better aesthetics.
• Ministernotomy was associated with significantly lower postoperative pain scores at multiple time points.

Conclusions:

• Both ministernotomy and minithoracotomy are safe and effective for minimally invasive AVR.
• Ministernotomy offers advantages in reduced postoperative pain and pleural complications.
• Minithoracotomy excels in providing superior wound aesthetics.