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Right minithoracotomy versus full sternotomy for the aortic valve replacement: Preliminary results

2011; Elsevier BV; Volume: 21; Issue: 3 Linguagem: Inglês

10.1016/j.hlc.2011.10.004

1444-2892

Fabrizio Sansone, Giuseppe Punta, Francesco Parisi, Guglielmo Mario Actis Dato, Edoardo Zingarelli, Roberto Flocco, Pier Giuseppe Forsennati, Gian Luca Bardi, Stefano del Ponte, Riccardo Casabona,

Cardiac Valve Diseases and Treatments

Background Minimally invasive surgery (MIS) for aortic valve replacement (AVR) is going to increase with different techniques described so far. We hereby report the results of AVR through a right minithoracotomy (RM) compared to a median sternotomy (MS). Materials and methods One hundred patients operated for isolated AVR by the same surgeon (chief of the department) were enrolled and allocated to: •MS (group A, 50 patients, 26 females, mean age 69.9 ± 12.4 years). •RM (group B, 50 patients, 27 females, mean age 71.6 ± 11.2 years). Mean logistic Euroscores were, respectively, 6.5 ± 4.0 and 8.0 ± 5.9 (p = ns). Results Mean duration of cardiopulmonary by-pass (CPB) was 62.8 ± 18.3 min in group A and 101.4 ± 35.2 min in group B (p < 0.05); cross-clamp was 44.8 ± 13.4 min in group A and 74.6 ± 26.7 min in group B (p < 0.05). Thirty-day mortality was 2 (4%) in group A and 0 in group B (p = ns). ICU stay and hospital stay did not significantly differ amongst two groups. The incidence of bleeding was lower in group B, showing a slight reduction of blood transfusions and re-explorations (p = ns). Conclusions Our experience shows that RM offers a good 30-day survival and a lower incidence of mediastinitis or osteomyelitis. The risk of insufficient vision or sudden complications is safely managed by enlarging the surgical incision through a transverse sternotomy. Minimally invasive surgery (MIS) for aortic valve replacement (AVR) is going to increase with different techniques described so far. We hereby report the results of AVR through a right minithoracotomy (RM) compared to a median sternotomy (MS). One hundred patients operated for isolated AVR by the same surgeon (chief of the department) were enrolled and allocated to: •MS (group A, 50 patients, 26 females, mean age 69.9 ± 12.4 years). •RM (group B, 50 patients, 27 females, mean age 71.6 ± 11.2 years). Mean logistic Euroscores were, respectively, 6.5 ± 4.0 and 8.0 ± 5.9 (p = ns). Mean duration of cardiopulmonary by-pass (CPB) was 62.8 ± 18.3 min in group A and 101.4 ± 35.2 min in group B (p < 0.05); cross-clamp was 44.8 ± 13.4 min in group A and 74.6 ± 26.7 min in group B (p < 0.05). Thirty-day mortality was 2 (4%) in group A and 0 in group B (p = ns). ICU stay and hospital stay did not significantly differ amongst two groups. The incidence of bleeding was lower in group B, showing a slight reduction of blood transfusions and re-explorations (p = ns). Our experience shows that RM offers a good 30-day survival and a lower incidence of mediastinitis or osteomyelitis. The risk of insufficient vision or sudden complications is safely managed by enlarging the surgical incision through a transverse sternotomy.