Mini-sternotomy versus full sternotomy aortic valve replacement: a single-centre experience.

Abstract

Background: full sternotomy (FS) is the gold standard approach to perform surgical aortic valve replacement (AVR). However, potential advantages of a less traumatic approach fomented the development of so-called minimally invasive procedures, which include upper mini-sternotomy (MS).

Objective: to compare immediate postoperative clinical results and mid-term mortality after AVR through MS and FS.

Methods: single-centre retrospective study including all patients who underwent isolated AVR through MS between January 1, 2011 and July 31, 2017. These were then matched with patients who underwent the same procedure through FS and by the same surgeons who performed MS, using coarsened exact matching for the variables age, gender, body mass index and diabetes mellitus. Groups were later characterized and compared regarding postoperative results using Qui- -squared and Mann-Whitney tests and regarding mid-term mortality through Kaplan-Meier curves.

Results: we included 82 patients (n=41 in each group). Aortic cross clamp [78 vs. 63 minutes, p=0.001] and cardiopulmonary bypass times [107 vs. 90 minutes, p=0.002] were significantly longer in the MS group vs. FS group, respectively. Although without reaching statistical significant difference, a smaller percentage of patients from the MS group required red blood cells transfusions during surgery (39.0% vs. 53.7%, p=0.184). Similar results were found regarding mechanical ventilation, inotropic support, morphine infusion, intensive care unit length of stay and incidence of de novo atrial fibrillation. Cumulative survival at 6 years was 86.7% after MS and 88.5% after FS (p=0.650).

Conclusions: Aortic valve replacement through MS seems to be a safe alternative to the gold standard FS.