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

doi:10.1016/j.athoracsur.2005.12.011

The Annals of Thoracic Surgery

Volume 81, Issue 5, May 2006, Pages 1599-1604

https://doi.org/10.1016/j.athoracsur.2005.12.011 Get rights and content

Background

Minimally invasive aortic valve replacement through partial upper sternotomy has been shown to reduce surgical trauma, and, supposedly, decrease postoperative pain, blood loss, and hospital stay.

Methods

From October 1997 until November 2004, 506 patients received isolated aortic valve replacement, of which 232 underwent the minimal access J-sternotomy approach (group 1). The control group (group 2) consisted of 274 patients who underwent aortic valve replacements by median sternotomy. We retrospectively reviewed outcomes of the patients in the early follow-up period.

Results

In group 1 and group 2, respectively, early mortality was 2.6% (6 patients) and 4.4% (12 patients). The minimal access group had reduced aortic cross-clamp and cardiopulmonary bypass times compared with conventional group: 61.8 ± 16.6 versus 69.5 ± 16.6 minutes (p < 0.05) and 88.8 ± 23.2 versus 100.2 ± 22.6 minutes (p < 0.05), respectively. Mean blood loss was lower in group 1 compared with group 2 (p < 0.05). Intensive care unit and hospital stays were shorter in the minimal access group: 2.1 ± 2.5 versus 2.5 ± 5.3 days (p = nonsignificant) and 10.8 ± 7.1 versus 12.8 ± 10.6 days (p < 0.05), respectively.

Conclusions

Aortic valve replacement can be performed safely through a partial upper sternotomy on a routine basis for isolated aortic valve disease.

Section snippets

Material and Methods

This is a retrospective, nonrandomized review of a single-center series of AVR using either a partial or complete sternotomy approach. The Institutional Review Board approved this study. Individual consent was waived as data collection was obtained from patient records and the departmental database. A total of 506 patients underwent an aortic valve replacement as their first cardiac operation between October 1997 and November 2004. Of these, 232 were operated through a partial upper J

Results

The types of valves implanted were similar for the two groups of patients (Table 4). Intraoperative characteristics of the two groups of patients are detailed in Table 4. Aortic cross-clamp and ECC times were shorter in minimal access AVR patients, and statistically significant differences were noted for these variables. Except for 1 patient in the conventional group, patients in both groups were successfully weaned from ECC without the need for mechanical circulatory support. None of the

Comment

Over the last decade, several studies have demonstrated excellent postoperative outcomes among patients undergoing different minimally invasive approaches for cardiac surgical procedures [2]. After various studies on the feasibility and possible advantages of minimally invasive AVR, we have adopted the reversed J sternotomy approach for minimal access aortic valve surgery in the second half of 1997. It is well known that most of the incision-related complications of new techniques occur in the

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

Background

Methods

Results

Conclusions

Section snippets

Material and Methods

Results

Comment

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

Am J Cardiol

Ann Thorac Surg

Ann Thorac Surg

Do patients want minimally invasive aortic valve replacement?

Eur J Cardiothorac Surg

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