The Heart Valve Society

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Minimally Invasive Aortic Valve Replacement: Ministernotomy or Minithoracotomy?
Mauro Del Giglio, M.D., Elisa Mikus, Simone Calvi.
Maria Cecilia Hospital, GVM for Care & Research, Cotignola (Ra), Italy.

OBJECTIVE: Actually two minimally invasive surgical approaches have been mainly adopted for aortic valve replacement. The most popular access adopted is the upper ministernotomy, because it provides an easy access to the aortic root and the possibility to switch to full sternotomy in case of complications is very simple, but interest on right minithoracotomy is increasing. This study describes 6 years experience using upper "J" hemisternotomy or right anterior minithoracotomy underling advantages and disadvantages for each technique with the aim to find the better surgical approach for each patient.
METHODS: From January 2010 to October 2016, 1251 patients underwent isolated minimally invasive aortic valve replacement at Author's Institution. Of them 801 (435 male, mean age 7310) were treated with upper mini-stermotomy, the remaining 450 (248 male, mean age 7211) through a right anterior mini-thoracotomy. Intraoperative data and postoperative outcomes, in terms of intensive care unit stay, blood loss, transfusions and sternal complications have been analyzed.
RESULTS: All patients received an aortic valve replacement using standard surgical technique and equipment. Mean cardiopulmonary bypass time and median cross-clamp time were respectively 7024 min and 5820 min for the ministernotomy group and 5921 min and 4717 min for the minithoracotomy one. Post operative analysis show similar outcomes in term of ventilation time (p=0.96), intensive care unit stay (p=0.41), reoperation for bleeding (p=0.10), atrial fibrillation and pace maker implantation (both p=1). Necessity of red blood cell transfusionhas been statistically significant (p=0.001), higher in the ministernotomy group . Twenty patients died in the ministernotomy group (mortality 2.4%), seven (1.55%) in the minithoracotomy one.
CONCLUSIONS: in our experience both techniques show encouraging results. Right anterior minithoracotomy is often considered a more complicated then upper "J" hemisternotomy but after an adequate learning curve and according with technical expedients, the right minithoracotomy shows potential interesting advantages.


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