Related Experiment Video
Updated: Jul 30, 2026
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Bleeding in minimally invasive versus conventional aortic valve replacement
Sorosh Bratt1,2, Axel Dimberg1,2, Mikael Kastengren2,3
1Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, SE-17176, Sweden.
Insights
Minimally invasive aortic valve replacement showed no reduction in bleeding compared to full sternotomy. This randomized trial found similar rates of severe bleeding, transfusions, and re-exploration between the two surgical approaches.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Aortic Valve Replacement
Background:
- Observational studies suggest less bleeding with minimally invasive aortic valve replacement (AVR) versus full sternotomy.
- However, data from randomized controlled trials (RCTs) on this topic remain conflicting.
Purpose of the Study:
- To compare bleeding-related outcomes between minimally invasive AVR (ministernotomy) and full sternotomy AVR in adult patients with aortic stenosis.
Main Methods:
- A Swedish single-center randomized trial assigned 100 adult patients with aortic stenosis to either ministernotomy or full sternotomy AVR.
- The primary outcome was severe or massive bleeding, defined by the Universal Definition of Perioperative Bleeding (UDPB).
- Secondary outcomes included blood product transfusions, chest tube output, and re-exploration for bleeding.
Main Results:
- No significant difference in severe or massive postoperative bleeding was observed between the ministernotomy (6%) and full sternotomy (6%) groups (p=1.00).
- Mean chest tube output in the first 12 hours was similar (270 ml vs. 350 ml, p=0.08).
- Rates of packed red blood cell transfusion (36% vs. 28%, p=0.39) and re-exploration for bleeding (4% vs. 4%) were also comparable.
Conclusions:
- Minimally invasive AVR via ministernotomy did not lead to significantly less bleeding-related outcomes compared to full sternotomy AVR.
- The findings suggest that the perceived bleeding advantage of minimally invasive AVR may not be consistently demonstrated in randomized trials.
Background:
Observational studies have shown reduced perioperative bleeding in patients undergoing minimally invasive, compared with full sternotomy, aortic valve replacement. Data from randomized trials are conflicting.
Methods:
This was a Swedish single center study where adult patients with aortic stenosis, 100 patients were randomly assigned in a 1:1 ratio to undergo either minimally invasive (ministernotomy) or full sternotomy aortic valve replacement. The primary outcome was severe or massive bleeding defined by the Universal Definition of Perioperative Bleeding in adult cardiac surgery (UDPB). Secondary outcomes included blood product transfusions, chest tube output, re-exploration for bleeding, and several other clinically relevant events.
Results:
Out of 100 patients, three patients randomized to ministernotomy were intraoperatively converted to full sternotomy (none was bleeding-related). Three patients (6%) in the full sternotomy group and 3 patients (6%) in the ministernotomy group suffered severe or massive postoperative bleeding according to the UDPB definition (p = 1.00). Mean chest tube output during the first 12 postoperative hours was 350 (standard deviation (SD) 220) ml in the full sternotomy group and 270 (SD 190) ml in the ministernotomy group (p = 0.08). 28% of patients in the full sternotomy group and 36% of patients in the ministernotomy group received at least one packed red blood cells transfusion (p = 0.39). Two patients in each group (4%) underwent re-exploration for bleeding.
Conclusions:
Minimally invasive aortic valve replacement did not result in less bleeding-related outcomes compared to full sternotomy.
Clinical Trial Registration:
http://www.
Clinicaltrials:
gov . Unique identifier: NCT02272621.
