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Published on: May 21, 2017
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.
Background:
Minimally invasive approaches to isolated aortic valve replacement (AVR) are well-described and widely utilized. While there are numerous proposed benefits, there is limited literature describing significant morbidity or mortality benefits for minimally invasive isolated AVR resulting in hesitancy in its universal adoption. In this retrospective study, we compare the 5-year outcomes of patients undergoing isolated AVR via full sternotomy (FS) or mini-sternotomy (MS).
Methods:
756 patients underwent isolated AVR between 2014 and 2019. Propensity matching resulted in 142 matched pairs that received either FS or MS. The primary outcome was mortality during the follow-up period. Secondary outcomes included intraoperative variables and postoperative morbidity.
Results:
Intraoperative variables including total operative, cardiopulmonary bypass, and aortic cross-clamp times did not differ significantly between groups. Postoperative mortality was similar between the matched groups with nonsignificant differences at 30 days (2.12% vs. 1.4%, p = .657), 1 year (4.9% vs. 2.1%, p = .0.223), and 5 years (7.5% vs. 3.5%, p = .174). Rates of postoperative morbidity were comparable between groups with no significant differences.
Conclusion:
This study examined the long-term outcomes of propensity-matched patients undergoing isolated AVR via FS or MS and identified no significant differences in outcomes over a 5-year follow-up period. The decision for surgical approach is multifactorial and should be decided on a case-by-case basis taking into consideration patient anatomy, surgeon experience, and comfort, as well as patient preference.
Insights
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.
