Mini Sternotomy and Mini Thoracotomy for Aortic Valve Replacement: Is There a Difference?
DOI:
https://doi.org/10.1532/hsf.4029Keywords:
mini AVR, ministernotomy, minithoracotomy, aesthetic AVRAbstract
Background: Minimally invasive valve replacement is increasingly accepted among surgeons and patients alike. Ministernotomy and minithoracotomy are the most used incisions in the minimally aortic valve replacement. The superiority of one incision over the other still is debatable with a few centers having the opportunity to compare them head-to-head.
Methods: A retrospective analysis of 260 patients, who underwent mini AVR, with 132 patients in the ministernotomy group and 128 patients in the minithoracotomy group. Operative details, mortality, wound cosmetics, and postoperative pain were among the primary end points.
Results: A predominance of female gender has been observed in both groups. The cross-clamp and total bypass times were significantly lower in MS compared with the MT approach (63.61±16.115 vs. 70.75±33.274 min, P = 0.028, and 91.90±26.365 vs. 112.24±51.634 min, P < 0.001, respectively). The minithoracotomy group had significantly shorter lengths of wounds (5.1 ± 0.6 vs. 8.48±0.344 cm, P < 0.001). The ministernotomy group had significantly lower postoperative pain scores either in the ICU, at hospital discharge, or after 30 days at the outpatient clinic, where scores compared with MT (4.46±1.23 vs. 5.23±1.12, P < 0.001, 1.6±0.84 vs. 1.83±0.72, P = 0.019, and 1.28±0.67 vs. 1.47±0.53, P = 0.012, respectively).
Conclusion: Both minimally invasive incisions for AVR proved their safety and efficacy. While the ministernotomy has the advantage of less postoperative pain and pleural complications, the minithoracotomy incision has its unmatched aesthetic appeal.
References
Amer M, Al Jawad MA, Omar A, Metwaly H. 2020. Safety and Haemodynamic Outcomes of Currently Available Suture-less Aortic Valves in Patients With Aortic Stenosis: A Meta-Analysis. Heart, Lung and Circulation. 29(9):1301-1309.
Bonacchi M, Dokollari A, Parise O, et al. 2021. Ministernotomy compared with right anterior minithoracotomy for aortic valve surgery. The Journal of Thoracic and Cardiovascular Surgery.
Bonacchi M, Prifti E, Giunti G, Frati G, Sani G. 2002. Does ministernotomy improve postoperative outcome in aortic valve operation? A prospective randomized study. The Annals of Thoracic Surgery. 73(2):460-465.
Bonow RO, Greenland P. 2015. Population-Wide Trends in Aortic Stenosis Incidence and Outcomes. Circulation. 131(11):969-971.
Brown JM, O'Brien SM, Wu C, Sikora JA, Griffith BP, Gammie JS. 2009. Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: Changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database. The Journal of Thoracic and Cardiovascular Surgery. 137(1):82-90.
Durdu MS, Baran Ç, Gümüş F, et al. 2018. Comparison of minimally invasive cardiac surgery incisions: Periareolar approach in female patients. Anatol J Cardiol. 20(5):283-288.
Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017. ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg. 52:616-64.
Ghanta RK, Lapar DJ, Kern JA, et al. 2015. Minimally invasive aortic valve replacement provides equivalent outcomes at reduced cost compared with conventional aortic valve replacement: A real-world multi-institutional analysis. The Journal of Thoracic and Cardiovascular Surgery. 149(4):1060-1065.
Jahangiri M, Hussain A, Akowuah E. 2019. Minimally invasive surgical aortic valve replacement. Heart. 105(Suppl 2):s10-5.
Massimo Massetti, Patrick Nataf, Gerard Babatasi, André Khayat. 1999. Cosmetic aspects in minimally invasive cardiac surgery, European Journal of Cardio-Thoracic Surgery, Volume 16, Issue Supplement_2, November. Pages S73–S75.
Nguyen TC, Terwelp MD, Thourani VH, et al. 2017. Clinical trends in surgical, minimally invasive and transcatheter aortic valve replacement†. European Journal of Cardio-Thoracic Surgery. 51(6):1086-1092.
Olds A, Saadat S, Azzolini A, et al. 2019. Improved operative and recovery times with mini-thoracotomy aortic valve replacement. Journal of Cardiothoracic Surgery. 14(1).
Schmitto JD, Mokashi SA, Cohn LH. 2010. Minimally-invasive valve surgery: the state of the art. J Am Coll Cardiol. 56:455-62.
Tanaka, D, Nedadur, R, Yanagawa, B. 2021. Rapid deployment valves: Another tool in the toolbox. J Card Surg. 1- 2.
