Mini-Sternotomy Versus Conventional Sternotomy for Aortic Valve Replacement

Hancock, Helen; Maier, Rebecca; Kasim, Adetayo; Mason, James; Murphy, Gavin J.; Goodwin, Andrew T.; Owens, W. Andrew; Kirmani, Bilal H.; Akowuah, Enoch

doi:10.1016/j.jacc.2019.03.462

Cited by 26 publications

(32 citation statements)

References 3 publications

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“…Our study showed that UHS results in a significantly lower postoperative blood loss in comparison to FS, which is consistent with other studies [4,8,12,13]. However, this was not reflected by a lower requirement for blood transfusion, as previously reported by Lim et al [6] and Hancock et al [13].…”

Section: Resultssupporting

confidence: 93%

Pulmonary function and quality of life after aortic valve replacement through ministernotomy: a prospective randomized study

Gofus¹,

Vobornik²,

Koblížek³

et al. 2020

Kardiol Pol

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Section: Resultssupporting

confidence: 93%

Pulmonary function and quality of life after aortic valve replacement through ministernotomy: a prospective randomized study

Gofus¹,

Vobornik²,

Koblížek³

et al. 2020

Kardiol Pol

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“…Computerized tomography (CT) was performed preoperatively to all cases to assess the aortic root position, the alpha angle, and the sternal to root distance. Candidate patients for the mini-sternotomy approach required more than 50% of the aortic root behind the sternum [2]. CT is of crucial importance for the exclusion of porcelain aorta and has a better role in stratification of cases eligible for the right anterior mini-thoracotomy approach.…”

Section: Preoperative Stratificationmentioning

confidence: 99%

“…Following general anesthesia, the FS group had a full sternotomy, while the MS group underwent a 5-7 cm upper sternotomy skin incision followed by a 10 cm upper inverted T hemi-sternotomy using a primary sternal blade for longitudinal osteotomy and a redo blade for the transverse sternotomy [2] at the level of the third intercostal space. The conventional group had a classical full median sternotomy.…”

Section: Surgical Techniquementioning

confidence: 99%

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Minimally invasive aortic valve replacement with central cannulation: A cost-benefit analysis in a developing country

Sanad

Beshir

2020

Cardiothorac Surg

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Background: Minimally-invasive approaches to aortic valve replacement (MIAVR) are technically and logistically demanding. However, few centers have started using these approaches with standard equipment because of the limited resources. We sought to report intra-and postoperative clinical outcomes and address health resource utilization after MIAVR. Results: A total of 102 eligible patients who had aortic valve replacement were enrolled in a prospective, multicenter cohort study conducted from June 2015 to December 2017. Fifty patients underwent aortic valve surgery via upper inverted T-shaped hemi-sternotomy (MS), and 52 patients were operated using full sternotomy (FS) in two centers in a developing country. Central cannulation was performed in all cases. Major adverse cardiac events, pain, and wound complications were compared. A cost analysis was performed, and exposure and feasibility for cannulation were assessed. The mean length of MS skin incision was 5.82 ± 0.67 cm. Cumulative cross-clamp time was insignificant between both groups (91.87 ± 34.41 versus 94.91 ± 33.96 min; p = 0.66). MS exhibited shorter ventilation time (6.18 ± 1.86 versus 10.68 ± 12.78 h; p = 0.029) and intensive care stays (33.27 ± 19.75 versus 49.42 ± 47.1 h; p = 0.037). Major adverse cardiac events (MACEs) were compared, and MS group exhibited fewer transfusions (1.18 ± 0.89 versus 1.7 ± 0.97 units; p = 0.002), fewer pulmonary complications (1 (2%) versus 2 (3.8%); p < 0.001), and less sternotomy wound infection (1 (2%) versus 5 (9.6%); p = 0.048). Total operative mortality of 4.46% was recorded (n = 5). Significant cost reduction was recorded favoring MS; central cannulation saved $907.16 and carried a total cost reduction of $580 (9.3%) when compared with the FS approach (p < 0.0001). Conclusions: With a lack of logistics in developing countries, MIAVR not only has a cosmetic advantage but carries a significant reduction in blood use, respiratory complications, pain, and cost. MIAVR can be feasible, with a rapid learning curve in developing centers.

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“…The most common surgical technique utilised involves a mini-sternotomy approach, which could potentially improve post-operative recovery, shorten intensive care and hospital stay, and increase patient satisfaction overall due to superior cosmetic results [10][11][12][13][14][15][16][17][18]. However, these procedures are also associated with a higher grade of complexity and subsequently longer cardiopulmonary bypass (CPB) and aortic cross-clamp times [19,20], and have therefore not become widely popular.…”

Section: Introductionmentioning

confidence: 99%

Benefits of rapid deployment aortic valve replacement with a mini upper sternotomy

Chien

Clark

Maheshwari

et al. 2020

J Cardiothorac Surg

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Background: Surgical aortic valve replacement (AVR) is currently deemed the gold standard of care for patients with severe aortic stenosis. Currently, most AVRs are safely performed through a full median sternotomy approach. With an increasingly elderly and high-risk patient population, major advances in valve technology and surgical technique have been introduced to reduce perioperative risk and post-operative complications associated with the full sternotomy approach, in order to ensure surgical AVR remains the gold standard. For example, minimally invasive approaches (most commonly via mini sternotomy) have been developed to improve patient outcomes. The advent of rapid deployment valve technology has also been shown to improve morbidity and mortality by reducing cardiopulmonary bypass and aortic cross-clamp times, as well as facilitating the use of minimal access approaches. Rapid deployment valves were introduced into our department at the Royal Infirmary of Edinburgh in 2014. The aim of this study is to investigate if utilising the combination of rapid deployment valves and a mini sternotomy minimally invasive approach resulted in improved outcomes in various patient subgroups. Methods: Over a 3-year period, we identified 714 patients who underwent isolated AVR in our centre. They were divided into two groups: 61 patients (8.5%) were identified who received rapid deployment AVR via J-shaped mini upper sternotomy (MIRDAVR group), whilst 653 patients (91.5%) were identified who received either a full sternotomy (using a conventional prosthesis or rapid deployment valve) or minimally invasive approach using a conventional valve (CONVAVR group). We retrospectively analysed data from our cardiac surgery database, including pre-operative demographics, intraoperative times and postoperative outcomes. Outcomes were also compared in two different subgroups: octogenarians and high-risk patients.

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Mini-Sternotomy Versus Conventional Sternotomy for Aortic Valve Replacement

Cited by 26 publications

References 3 publications

Pulmonary function and quality of life after aortic valve replacement through ministernotomy: a prospective randomized study

Pulmonary function and quality of life after aortic valve replacement through ministernotomy: a prospective randomized study

Minimally invasive aortic valve replacement with central cannulation: A cost-benefit analysis in a developing country

Benefits of rapid deployment aortic valve replacement with a mini upper sternotomy

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