The Heart Valve Society

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Aortic Valve Replacement via Partial Sternotomy as the Standard Incision: Short-term Outcomes and Comparison of Conventional and Sutureless Prostheses
Petr Budera, Miroslav Kolesar, David Talavera, Zbynek Straka.
University Hospital Kralovske Vinohrady, Prague 10, Czech Republic.

OBJECTIVE: Partial sternotomy is becoming a preffered approach for surgical aortic valve replacement(AVR). Usage of sutureless bioprostheses is also expanding, especially in minimally invasive approaches. METHODS: Data of patients from our institution, who underwent isolated AVR in last 3 years were retrospectively analyzed. Partial J-sternotomy with the use of central cannulation of cardiopulmonary bypass was a preffered surgical approach of all surgeons. Baseline, perioperative and 30-days outcomes were analyzed. Moreover, a comparison of perioperative outcomes of conventional and sutureless prostheses implantation was performed for purpose of this study. RESULTS: Of 154 patients who underwent AVR between 2014-2016, 140 (91%) was operated via partial sternotomy. Their mean age was 70 years (34-88), mean ejection fraction was 58 % (20-75), mean body mass index was 30 kg/m2(20-47). Thirty-two (23%) patients received a mechanical and 108 (77%) a biological prosthesis; 40 (39%) patients received a sutureless bioprosthesis. Mean operation time was 14025min, time of cardiopulmonary bypass was 5816min and cross-clamp time 4612min. Four(3%) patients must have been converted to full sternotomy. In thirty postoperative days, 3(2%) patients died, 3(2%) patients had a re-exploration for bleeding, 1(1%) patient had a deep sternal wound infection and 4(3%) underwent a thoracoscopic revision for pericardial effusion. Of other complications, 3(3%) had a renal failure, 1(1%) had infective endocarditis, 2(2%) had a stroke/TIA, 43(31%) had a postoperative atrial fibrillation and 4(3%) had a small paravalvular leak at 30-days echocardiography visit. Patients who received a sutureless valves had significantly lower mean operation time compared to conventional valves (130 vs. 144 min, p=0.004), mean time of cardiopulmonary bypass (48 vs. 62 min, p<0.001) and also mean cross-clamp time (37 vs. 50 min, p<0.001). Drainage loss (342 vs. 368 ml) and time of mechanical ventilation (432 vs. 413 min) was similar in both groups.
CONCLUSIONS: Minimally invasive AVR via partial sternotomy is a safe procedure with excellent results. The use of sutureless valves may reduce the times of surgery, cross-clamp and cardiopulmonary bypass.


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