Multicenter Prospective Comparative Study between Upper Mini-Sternotomy, and Right Anterior Mini-Thoracotomy for Isolated Aortic Valve Replacement

Document Type : Original Article

Authors

1 Cardiothoracic Surgery Department, Faculty of Medicine, Minia University, Egypt.

2 Cardiac Surgery Department, King Salman Heart Center, King Fahad Medical City, Riyadh, KSA.

3 Cardiac Surgery Department, Madinah Cardiac Center, Madinah, KSA.

4 King Faisal University, KSA.

5 Cardiothoracic Surgery Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.

Abstract

Background: Surgical Aortic valve replacement (sAVR) is one of the most common valve surgery associated with excellent Results. SAVR can be performed via a full sternotomy (FS) or a minimal invasive surgical (MIS) approach. Many studies compared outcomes of AVR through upper mini-sternotomy (UMS) versus full sternotomy (FS) and others compared right anterior mini-thoracotomy (RAMT) versus full sternotomy (FS). Our aim was to compare early outcomes of AVR by UMS versus RAMT.
Materials and Methods: The prospective, randomized, comparative multicenter study compared surgical and early outcomes of patients who underwent elective isolated SAVR from January 2021 to January 2024. All consecutive patients had aging group 65-75 years old. Patients are divided into two groups; group [RAMT] and group [UMS]. Selection of RAMT groups according to preoperative chest computed tomography (CT). All patients who had severe aortic stenosis [AS] received a bioprosthetic valve suture bioprosthetic, group [S], or sutureless (Perceval) [SURD].
Results: No differences in both groups about age, preoperative risk factors, and postoperative complications. Operative time was significantly shorter for the SURD group, regardless of approach. However, nowadays a core- knot in the suture valve made almost no time difference. UMS group had less postoperative pain than RAMT group, however with using analgesic and pain killer made differences not obvious. RAMT group had more lung atelectasis, pleural effusion, and limited mobility of the right arm in the first few postoperative days. UMS group could be easily converted to FS if needed. The RAMT had more cosmetic and patient satisfaction.
Conclusions: Both approaches are nearly similar in early outcomes and consider the future of total endoscopic and robotic cardiac surgery.

Keywords

References

  1. Martin A, Paolo B, Marco S, Giuseppe S, Utz K, Antonio F, et al. Minimally invasive access type related to outcomes of sutureless and rapid deployment valves. Euro J Cardiothorac Surg. 2020:58; 1063–71
  2. Paolo B, Martin A, Bart M, Tom L, Marco S, Giovanni C, et al. Sutureless and rapid deployment versus sutured aortic valve replacement: a propensity-matched comparison from the Sutureless and Rapid Deployment International Registry. Euro J Cardiothorac Surg. 2022; 62(2): ezac378.
  3. Patrick K, Idserd D, Geoffrey L, Bart P. Planning for minimally invasive aortic valve replacement: key steps for patient assessment. Euro J Cardiothorac Surg. 2018; 53: ii3–ii8.
  4. Domenico P, Pietro G, Giuseppe S, Marco M, Piero G, Khalil F, et al. Full sternotomy and minimal access approaches for surgical aortic valve replacement: a multicenter propensity-matched study. Euro J Cardiothorac Surg.  2020; 57: 709–16.
  5. Marco S, Giacomo B, Francesca C, Rafik M, Enkel K, Tommaso G, et al. Right anterior mini-thoracotomy and sutureless valves: the perfect marriage. Annnals Cardiothorac Surg. 2020; 9(4):123-29.
  6. Paolo B, Sebastian A, Antonio F, Thierry P, Martin M, Kevin T, et al. Current trends of sutureless and rapid deployment valves: an 11-year experience from the Sutureless and Rapid Deployment International Registry. Euro J Cardiothorac Surg.  2022; 58: 1054–62.
  7. Christopher P, Shubhra S, Hunaid A. Outcomes of minimally invasive aortic valve replacement surgery. Euro J Cardiothorac Surg. 2018; 53: 19–23.
  8. Pyotr T, Helen H, Rebecca M, Jonathan A, Andrew G, Andrew O, et al. long term outcomes of mini sternotomy versus conventional sternotomy for aortic valve replacement: a randomized controlled trial. Euro J Cardiothorac Surg.2023:1(63) ezac540.
  9. Joe H, Seán B, Eileen D, Kishore D. Aortic Valve Replacement via Mini-Sternotomy: Results of a Single Centre Analysis. Doi.org/10.33178.SMJ.2024;1.3.
Journal of Cardio-Thoracic Medicine
Volume 12, Issue 2
June 2024
Pages 1343-1349

Files

Share

How to cite

Statistics