Limited versus full sternotomy for aortic valve replacement

Kirmani, Bilal H.; Jones, Steven P.; Chung, Darryl A; Williams, Richard JNN; Malaisrie, S. Chris

doi:10.1002/14651858.cd011793

Cited by 40 publications

(52 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Indeed, the rate of permanent pacemaker implantation was lower in the U.S. registry (16.4%, and 19.7% when the patients who had previously received pacemakers were excluded). 1 However, the rate in the SURTAVI trial is similar to that in our study from Geneva (23.9%), 2 a study from Israel (20.4%), 3 and a study from Germany (20.0%) 4 ( Table 1). We think that rates of permanent pacemaker implantation may be influenced by local practice.…”

Section: Doi: 101056/nejmc1706234supporting

confidence: 82%

See 1 more Smart Citation

Surgical or Transcatheter Aortic-Valve Replacement

2017

View full text Add to dashboard Cite

Section: Doi: 101056/nejmc1706234supporting

confidence: 82%

“…1 Furthermore, Lamoureux et al cite a meta-analysis that showed that the clinical course of retinopathy changed between two periods: 1975-1985 and 1985-2005. 2 The DCCT/EDIC was conducted primarily during the second period, from 1983 through the present.…”

mentioning

confidence: 99%

Surgical or Transcatheter Aortic-Valve Replacement

2017

View full text Add to dashboard Cite

“…AddiƟonal records idenƟfied through other sources (n = 0) and hospital stay. 7,8 There is also evidence to suggest a lower transfusion requirement during surgery, 5 and a reduced volume of blood lost from chest drainage. 4,6 Mini-sternotomy (MS) and right anterior thoracotomy (RAT) are widely reported as minimally invasive approaches for AVR.…”

Section: Idenɵficaɵonmentioning

confidence: 99%

Mini‐sternotomy vs right anterior thoracotomy for aortic valve replacement

et al. 2020

View full text Add to dashboard Cite

Background While minimally invasive techniques for aortic valve replacement (AVR) have been shown to be safe, limited data exist comparing the varying approaches. This study aimed to compare the outcomes between two minimally invasive approaches for AVR: mini‐sternotomy (MS) and right anterior thoracotomy (RAT). Materials and Methods A systematic search of MEDLINE, EMBASE, and OVID was conducted for the period 1990‐2019. Nine observational studies (n = 2926 patients) met the inclusion criteria. Results There was no difference in operative mortality between MS and RAT (odds ratio [OR]: 0.87, 95% confidence interval [CI]: 0.41‐1.85; P = .709). Meta‐analyses favored MS over RAT in reoperation for bleeding (OR: 0.42, 95% CI: 0.28‐0.63; P < .001), aortic cross‐clamp time (standardized mean difference [SMD]: −0.12, 95% CI: −0.20 to 0.029; P = .009), and the rate of conversion to sternotomy (OR: 0.32, 95% CI: 0.11‐0.93; P = .036). The rate of permanent pacemaker insertion approached borderline significance in favor of MS (OR: 0.54, 95% CI: 0.26‐1.12; P = .097). In‐hospital outcomes of stroke, atrial fibrillation, and surgical site infection were similar between the two groups. The length of hospital stay was shorter for RAT (SMD: 0.12, 95% CI: 0.027‐0.22; P = .012) and the length of postoperative ventilation was borderline significant in favor of RAT (SMD: 0.16, 95% CI: −0.027 to 0.34; P = .095). Conclusions This study highlights important differences in short‐term outcomes between MS and RAT as approaches for AVR. This has important implications for patient selection, especially in the elderly, where such approaches are becoming more common‐place.

show abstract

“…Published reports suggest shorter ventilation time, reduced postoperative pain, bleeding and incidence of transfusion, fewer wound infections, shorter intensive care stay, and a quicker return to normal activities. 20 The presence of an undisturbed distal pericardium with few adhesions theoretically improves the operating conditions should further cardiac surgery be necessary. A Cochrane review in 2017 found no difference in mortality, bypass time, aortic clamp time, or the incidence of major adverse events between mAVR and conventional sternotomy.…”

Section: Minimal Access Aortic Valve Replacementmentioning

confidence: 99%

Anaesthesia for minimally invasive cardiac surgery

Parnell

Prince

2018

BJA Education

View full text Add to dashboard Cite

Discuss the absolute and relative contraindications for minimally invasive mitral valve surgery (MIMVS). Explain the role of transoesophageal echocardiogram (TOE) and why it is essential in MIMVS surgery. Summarise the main disadvantages of a ministernotomy compared with conventional full sternotomy for aortic valve surgery. Significant advances in cardiac surgery followed the introduction of cardiopulmonary bypass (CPB), which was first established in the early 1950s. Over time, refinements in surgical and anaesthetic techniques combined with improved technology and the use of intraoperative transoesophageal echocardiography (TOE) has enabled less invasive approaches using smaller surgical incisions. Several different approaches can be grouped under the umbrella term 'Minimally Invasive Cardiac Surgery' (MICS), with Cosgrove and colleagues describing the first minimally invasive valve procedures in 1996. 1 Despite being pioneered more than 20 yr ago, the complex nature of MICS has resulted in only a handful of centres in the UK regularly performing these procedures. Today, MICS encompasses minimally invasive direct coronary artery bypass (MIDCAB), robotic-assisted cardiac surgery, atrial fibrillation (AF) ablation surgery, and minimally invasive approaches to the mitral valve, left and right atria, and aortic valve. Advantages of MICS over a conventional midline sternotomy include reduced postoperative pain, early mobilisation, reduced blood loss, and a shorter hospital stay. 2,3 However, there are a number of potential drawbacks. MICS has been associated with additional complications to those after sternotomy, not all patient groups are suitable, and the surgical skills required to master video-assisted mitral valve repair procedures may involve a substantial learning curve to achieve expertise. MIDCAB surgery MIDCAB surgery describes a minimally invasive approach to coronary artery bypass grafting. This is usually performed using an 'off-pump' technique, avoiding the use of CPB and cardioplegia solution. Access is via a left anterior minithoracotomy plus additional ports, leading to faster recovery times and a shorter intensive care stay. 4,7 However, it is only suitable for one or two vessel coronary grafting, and careful patient selection is essential.

show abstract

Limited versus full sternotomy for aortic valve replacement

Cited by 40 publications

References 33 publications

Surgical or Transcatheter Aortic-Valve Replacement

Surgical or Transcatheter Aortic-Valve Replacement

Mini‐sternotomy vs right anterior thoracotomy for aortic valve replacement

Anaesthesia for minimally invasive cardiac surgery

Contact Info

Product

Resources

About