Upper reversed-T mini-sternotomy for sutureless aortic valve replacement: an alternative for high-risk patients

Sutureless aortic prostheses are designed to make aortic valve replacement easier than stented or stentless prostheses in patients with significant aortic stenosis. Recently, a more minimally invasive approach combining sutureless aortic valve replacement with small incisions has emerged, but concerns remain about reduced surgical visibility and the risk of permanent pacemaker implantation.

Between 2015 and 2023, 216 patients underwent sutureless aortic valve replacement; of these, only 124 patients who underwent isolated primary aortic valve replacement surgery for severe calcific aortic valve stenosis were included in this study to compare in-hospital outcomes between the upper reversed-T mini-sternotomy and full sternotomy approaches.

The mean age was 73.3 ± 7.1 years for full sternotomy [NK2] and 71.9 ± 5.7 years for mini sternotomy. The differences in preoperative risk factors, including associated cardiac pathologies, left ventricular functions, aortic valve pathologies, and aortic root status, were not significant. The mean aortic cross-clamp and associated total cardiopulmonary bypass times were higher in the mini-sternotomy group without any worsening of perioperative outcomes. Postoperative early complications were similar between the two groups, except for tube drainage and hospital stay, which were worse in the full sternotomy group.

In elderly patients with severe calcific aortic stenosis, sutureless aortic valve replacement via the upper reversed-T mini-sternotomy approach is at least as successful as the full sternotomy method and can be preferred in this patient group due to advantages such as less drainage and faster recovery.