Comparing mini-sternotomy to full median sternotomy for aortic valve replacement with propensity-matching methods

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Procedures
• Surgical Outcomes

Background:

• Aortic valve replacement (AVR) is a critical cardiac procedure.
• Traditional full median sternotomy provides wide surgical access.
• Minimally invasive techniques like mini-sternotomy aim to reduce surgical trauma and improve recovery.

Purpose of the Study:

• To compare clinical outcomes between mini-sternotomy and full median sternotomy for aortic valve replacement.
• To evaluate the safety and efficacy of mini-sternotomy versus full sternotomy using propensity-matched analysis.
• To identify potential advantages of mini-sternotomy in terms of postoperative recovery.

Main Methods:

• A retrospective study of 1,445 patients undergoing isolated AVR from August 2014 to July 2021.
• 198 patients underwent mini-sternotomy, while 1,247 underwent full median sternotomy.
• Propensity score matching based on 18 variables created 198 matched pairs to control for confounding factors.

Main Results:

• No significant differences were observed in in-hospital mortality, stroke, renal failure, or paravalvular leakage between the groups.
• Operation, cardiopulmonary bypass, and aortic cross-clamp times showed no significant variation.
• The mini-sternotomy group demonstrated significantly less postoperative 24-hour and total drainage compared to the full sternotomy group.

Conclusions:

• Mini-sternotomy is a safe and effective alternative for aortic valve replacement.
• It offers cosmetic benefits and reduced postoperative drainage compared to full sternotomy.
• Mini-sternotomy should be strongly considered for the majority of aortic valve operations.