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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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Mini-sternotomy versus full sternotomy for isolated aortic valve replacement: A single-center experience
Ryaan El-Andari1, Abigail White1, Nicholas M Fialka2
1Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Journal of Cardiac Surgery
|November 15, 2022
Summary
Minimally invasive aortic valve replacement (AVR) shows similar 5-year survival and morbidity compared to full sternotomy. The choice between mini-sternotomy (MS) and full sternotomy (FS) for AVR depends on individual patient factors.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Aortic Valve Replacement
Background:
- Minimally invasive aortic valve replacement (AVR) is widely used, but evidence for improved outcomes is limited.
- Hesitancy exists regarding universal adoption of minimally invasive AVR due to lack of demonstrated significant morbidity or mortality benefits.
- This study retrospectively compares 5-year outcomes of isolated AVR via full sternotomy (FS) versus mini-sternotomy (MS).
Purpose of the Study:
- To compare the 5-year outcomes of isolated aortic valve replacement (AVR) using full sternotomy (FS) versus mini-sternotomy (MS).
- To evaluate differences in mortality and postoperative morbidity between FS and MS approaches for AVR.
- To provide data to inform the decision-making process for selecting the optimal surgical approach for AVR.
Main Methods:
- Retrospective analysis of 756 patients undergoing isolated AVR between 2014 and 2019.
- Propensity matching created 142 pairs of patients who underwent either FS or MS.
- Primary outcome was 5-year mortality; secondary outcomes included intraoperative variables and postoperative morbidity.
Main Results:
- No significant differences in intraoperative variables (operative time, bypass time, cross-clamp time) between FS and MS groups.
- Similar 30-day, 1-year, and 5-year postoperative mortality rates between the propensity-matched FS and MS groups.
- Comparable rates of postoperative morbidity between the two surgical approaches with no significant differences.
Conclusions:
- This propensity-matched study found no significant differences in 5-year outcomes for isolated AVR between full sternotomy and mini-sternotomy.
- The choice between FS and MS for AVR should be individualized, considering patient anatomy, surgeon expertise, and patient preference.
- Long-term outcomes do not favor one surgical approach over the other for isolated AVR.
