Lower mini-sternotomy: an approach for treating all valvulopathies?

Background: Lower mini-sternotomy offers the advantage of providing excellent visualization of the 4 cardiac cavities, allowing surgical treatment of aortic, mitral and tricuspid valves as well as any intra-cavitary procedure. Technical issues, as well as safety and echocardiographic results of this approach, are lacking. The aim of this retrospective study was to describe outcomes of lower mini-sternotomy to treat valvulopathies and other intracardiac surgeries.

Methods: All consecutive patients over 18 who underwent cardiac surgery by mini-sternotomy between January 2017 and March 2023 in our institution (Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France) were included in this retrospective study. Main outcome variables were all-cause mortality, post-operative complications and echocardiographic results.

Results: During the 6-year study period, 633 patients were treated via a lower mini-sternotomy. Among them, 338 patients had aortic valve surgery (AVS) ± tricuspid annuloplasty (TA), 254 had mitral valve surgery (MVS) ± TA, 25 had AVS + MVS ± TA and 38 had other types of intracardiac surgery. Hospital survival was 99.1% in the AVS group, 98.1% in the MVS ± TA group, 96% in the AVS + MVS ± TA group and 97.4% in the other intracardiac surgery group. Only one patient required re-osteosynthesis in the entire cohort and 12 (2.1%) patients suffered from mediastinitis. 162 (25%) patients received transfusion, 11 patients (1.7%) had permanent stroke and 49 (7.5%) had new pacemaker implantation.

Conclusions: lower mini-sternotomy is a safe approach for treating all valvulopathies, separately or concomitantly, or other intra-cardiac pathologies with a low rate of morbi-mortality.