Minimally Invasive Versus Standard Approach Aortic Valve Replacement: A Study in 506 Patients

Bakır, İhsan; Casselman, Filip; Wellens, Francis; Jeanmart, Hugues; Geest, Raphaël De; Degrieck, Ivan; Praet, Frank Van; Vermeulen, Yvette; Vanermen, Hugo

doi:10.1016/j.athoracsur.2005.12.011

Cited by 168 publications

(141 citation statements)

References 25 publications

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“…[1][2][3][4][5][6][7][8][9][10] The technique utilized in our unit, i.e. J-sternotomy is also known as an upper hemisternotomy and is a routinely performed minimally invasive AVR technique in many centers.…”

Section: Discussionmentioning

confidence: 99%

“…The surgical technique was described previously. [3,4] After the induction of general anesthesia, in the minimally invasive group (group JS), a 6-8 cm midline skin incision was made beginning 2 cm above the angle of Louis until 4 to 6 cm below the angle. The sternotomy was incised with the oscillating saw down until the intercostal space between the second and fourth depending on the topographic relationships of the anatomic structures ( Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…After the original description of minimally invasive aortic valve replacement (AVR) with a right thoracotomy in the early 1990s, this approach, with a number of different variations, remains a viable alternative to a conventional sternotomy. [1][2][3][4][5][6][7] Despite the more common use of the parasternal and transverse approaches in the initial reports, upper hemisternotomy and right anterior minithoracotomy are frequently used in the current surgical practice. [3][4][5] The more frequent use of sutureless valves along with growing expertise may be expected to result in the more frequent use of minimally invasive approaches for AVR.…”

mentioning

confidence: 99%

“…[1][2][3][4][5][6][7] Despite the more common use of the parasternal and transverse approaches in the initial reports, upper hemisternotomy and right anterior minithoracotomy are frequently used in the current surgical practice. [3][4][5] The more frequent use of sutureless valves along with growing expertise may be expected to result in the more frequent use of minimally invasive approaches for AVR. [8,9] Clinically, surgery performed using smaller incisions offer a number of advantages such as reduced postoperative pain and surgical trauma.…”

mentioning

confidence: 99%

“…[8,9] Clinically, surgery performed using smaller incisions offer a number of advantages such as reduced postoperative pain and surgical trauma. [3][4][5] Also, a minimally invasive AVR appears to be superior to aortic valve surgery with a conventional sternotomy in terms of less bleeding, shorter ventilation and a reduced length of time in the intensive care unit and a shorter hospital stay. [1][2][3][4][5][6][7] Since we have only recently introduced minimally invasive AVR procedures in our center, we decided to share our clinical experience on AVR with a J-sternotomy during a one-year period in comparison with the conventional AVR in terms of clinical outcomes, early morbidity and early challenges.…”

mentioning

confidence: 99%

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J-sternotomy incision for aortic valve surgery: an initial experience of a tertiary care hospital

Erkanlı¹

2016

Cardiovasc Surg Int

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Objectives: This study aims to present our single-center experience of an aortic valve replacement using a minimally invasive J-sternotomy incision and to compare the early clinical outcomes of these procedures with a median sternotomy. Patients and methods:Between January 2014 and May 2015, 38 patients underwent isolated aortic valve replacement operations using a minimally invasive or a conventional sternotomy. A J-sternotomy (group JS) incision was used on 18 patients (12 males, 6 females; mean age 57.0±17.9 years; range 19 to 62 years), whereas a median sternotomy (group MS) incision was performed on 20 patients (13 males, 7 females; mean age 57.4±16.3 years; range 22 to 65 years). Preoperative characteristics, perioperative data and early outcomes were compared. Patient selection techniques, the surgical approach and our experience during the procedures were presented. Results:No mortality developed. The types (p=0.36) and dimensions (p=0.99) of implanted aortic valves were similar between the groups. There was no significant difference between the JS and MS groups in terms of cross-clamp (68.4±30.1 vs. 64.7±29.9 minutes, p=0.70) and cardiopulmonary bypass time (112.3±43.1 vs. 94.8±43.8 minutes, p=0.22). In the group JS, conversion to full sternotomy was needed in one patient due to poor surgical exposure. The lengths of intensive care unit [1.7±1.7 vs 2.2±1.2 days, (p=0.33)] and hospital [7.1±2.7 vs 7.2±1.2 days, (p=0.66)] stays were similar between the groups. A mediastinal exploration due to bleeding was performed using a full sternotomy in two patients (11.2%) from group JS. There was no significant difference in postoperative complications. Conclusion:Since it is minimally invasive for aortic valve replacement using a J-sternotomy incision is a safe and reproducible procedure. The use of a minimally invasive aortic valve replacement technique does not lead to a higher incidence of postoperative complications and associated mortality.

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