Mini-Stern Trial: A randomized trial comparing mini-sternotomy to full median sternotomy for aortic valve replacement

Nair, Sridevi; Sudarshan, Catherine; Thorpe, Benjamin; Singh, Jeshika; Pillay, Thasee; Catarino, Pedro; Valchanov, Kamen; Codispoti, Massimiliano; Dunning, John; Abu‐Omar, Yasir; Moorjani, Narain; Matthews, Claire; Freeman, Carol; Fox-Rushby, Julia; Sharples, Linda D.

doi:10.1016/j.jtcvs.2018.05.057

Cited by 50 publications

(62 citation statements)

References 19 publications

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“…The Mini-Stern trial randomised 222 patients to either a fourth space J sternotomy MIAVR or a conventional sternotomy 32. The primary outcome was to determine a difference in postoperative length of stay.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgical aortic valve replacement

Jahangiri

Hussain

Akowuah

2019

Heart

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Minimally invasive aortic valve replacement (MIAVR) is defined as a surgical aortic valve replacement which involves smaller chest incisions as opposed to full sternotomy. It is performed using cardiopulmonary bypass with cardiac arrest. It benefits from potential advantages of a less invasive procedure. To date, over 14 000 MIAVR have been reported in the literature. Due to heterogeneity of the studies, different surgical techniques and mainly the non-randomised nature of these studies comparing MIAVR with conventional aortic valve replacement, it is difficult to draw definitive conclusions. The two main techniques of MIAVR are mini-sternotomy and right anterior mini-thoracotomy. Both techniques with other less common forms of MIAVR will be discussed in this review. The advantages, disadvantages and surgical pitfalls will be discussed. Some of the advantages include shorter intensive care and hospital stay, reduced perioperative blood loss, less pain, improved respiratory function and cosmesis. The possible disadvantage of longer bypass and cross-clamp times may be counter balanced by the recent sutureless and rapid deployment valves. Despite some of the benefits, MIAVR has not been adopted by a significant proportion of the surgeons possibly related to the learning curve and requirements for re-training. As MIAVR becomes more common, randomised trials comparing this technique with transcatheter aortic valve implantation is warranted. In addition, assessing quality of life including return to work and functional capacity is needed.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive surgical aortic valve replacement

Jahangiri

Hussain

Akowuah

2019

Heart

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“…Rapid deployment and sutureless bioprosthetic aortic valves have also helped to facilitate the RAMT approach 8,9 . Recently, enthusiasm for minimally invasive AVR has been tempered by the results of the randomized controlled Mini‐Stern trial, which found no outcome advantage with minimally invasive AVR 10 . Importantly, this study did not include any patients that had a sternum‐sparing RAMT‐AVR 10 .…”

Section: Discussionmentioning

confidence: 99%

Right anterior minithoracotomy approach for resection of papillary fibroelastoma

2020

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Background Right anterior minithoracotomy (RAMT) is an alternative to full or partial sternotomy for accessing the aortic valve. The adoption of this approach for aortic valve replacement has been limited by its perceived technical complexity. Resection of a mobile aortic valve tumor is a simple procedure that is conventionally done through a sternotomy. Aim The following case describes the resection of an aortic valve papillary fibroelastoma through an RAMT. Materials & Methods This is a report on a single patient's case. Results The fibroelastoma was safely excised through a RAMT approach. Discussion An aortic valve fibroelastoma offers an ideal starting point for surgeons to begin using a RAMT approach. Conclusion The excision of aortic valve masses is a procedure that is well suited to minimally invasive strategies, and we suggest sternum‐sparing RAMT is the optimal approach.

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“…1 Interestingly, a recent randomized trial by Nair and colleagues 2 demonstrated no apparent clinical benefits with minimally invasive SAVR at the expense of increased costs. The results of that study and Fedak's recent editorial 3 have fueled further debate as to whether there is any advantage to minimally invasive techniques at all.…”

Section: Patient-reported Outcomes: How To Advance the Minimally Invamentioning

confidence: 93%

“…2 In an effort to settle this debate, Nair and colleagues 3 presented results of the Mini-Stern Trial in the December 2018 issue of the Journal. In a study of 222 patients randomly allocated across 2 sites in the United Kingdom, Nair and colleagues 3 found that aortic valve replacement through an upper ministernotomy (MS) did not result in shorter stay, faster recovery, or improved survival relative to full sternotomy. MS was also associated with an increased cost of £1714 per patient, which appeared largely driven by increased perioperative expenses.…”

Section: Patient-reported Outcomes: How To Advance the Minimally Invamentioning

confidence: 99%

Patient-reported outcomes: How to advance the minimally invasive debate

Percy

Hirji

Kaneko

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Mini-Stern Trial: A randomized trial comparing mini-sternotomy to full median sternotomy for aortic valve replacement

Abstract: Compared with FS for AVR, MS did not result in shorter hospital stay, faster recovery, or improved survival and was not cost-effective. The MS approach is not superior to FS for performing AVR.

Cited by 50 publications

References 19 publications

Minimally invasive surgical aortic valve replacement

Minimally invasive surgical aortic valve replacement

Right anterior minithoracotomy approach for resection of papillary fibroelastoma

Patient-reported outcomes: How to advance the minimally invasive debate

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