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Related Experiment Video

Updated: Jun 23, 2025

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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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.

Journal of Cardiothoracic Surgery
|June 21, 2024
PubMed
Summary

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.

Keywords:
Aortic valve surgeryBleedingMinimally invasive surgeryMinisternotomy

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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.