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. 2022 Apr;14(4):857-865.
doi: 10.21037/jtd-21-1494.

Partial upper sternotomy for aortic valve replacement provides similar mid-term outcomes as the full sternotomy

Jan Hlavicka  1   2 , David Janda  2 , Petr Budera  2 , Petr Tousek  3 , Marek Maly  4 , Richard Fojt  2 , Hana Linkova  3 , Tomas Holubec #  1 , Petr Kacer #  2
Affiliations

Partial upper sternotomy for aortic valve replacement provides similar mid-term outcomes as the full sternotomy

Jan Hlavicka et al. J Thorac Dis. 2022 Apr.

Abstract

Background: Minimally invasive aortic valve replacement via upper partial sternotomy (MiniAVR) provides very good short-term results and delivers certain advantages in the postoperative course. There is limited data regarding the mid-term mortality and morbidity following this minimally invasive surgery.

Methods: We provide a retrospective analysis of the patients, undergoing MiniAVR versus full sternotomy (FS) for aortic valve replacement with biological prosthesis. As the primary combined end-point the combination of death, stroke, and rehospitalization within 3 years postoperatively was defined. Data have been collected from National Cardiac Surgery Registry and insurance companies.

Results: Two hundred consecutive patients with aortic valve replacement (100 ministernotomy in MiniAVR group and 100 full sternotomy in FS group) with biological prosthesis were included in this study. Ministernotomy had longer cross-clamp and bypass times (median difference 6.5 min, P=0.005, and 8.5 min, P=0.002 respectively). Patients operated via upper partial sternotomy had a lower postoperative bleeding [300 mL (IQR, 290) vs. 365 mL (IQR, 207), P=0.031]. There was no difference in the 3-year mortality (14% vs. 11%, P=0.485). The mean number of readmission 3 years after surgery per capita was almost the same in both groups (1.65 vs. 1.60, P=0.836). Median time to the first readmission was longer in the MiniAVR group (difference 8.9 months). The incidence of combined end-point during 3 years postoperatively in both groups was not statistically different (P=0.148), as well as readmissions from cardio-vascular reasons (subhazard ratio 0.90, P=0.693).

Conclusions: Upper partial sternotomy can be performed safely for aortic valve replacement, without increased risk of death, stroke or re-admission in 3 years postoperatively.

Keywords: Minimally invasive; aortic valve; partial sternotomy.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-21-1494/coif). PT reports that he is supported by the scientific grant program of the Charles University Prague, Czech Republic (UNCE MED 02 and PROGRES Q38) and in the past received a part-time salary for lectures and presentations for the firms, Medtronic, B Braun and Abiomed. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Kaplan-Meier curves showing freedom from combined end-point according to the surgical approach. MiniAVR, upper partial sternotomy.
Figure 2
Figure 2
Kaplan-Meier curves showing survival in patients after aortic valve replacement. MiniAVR, upper partial sternotomy.
Figure 3
Figure 3
Kaplan-Meier curves showing freedom from rehospitalization 1, 2, and 3 according to the surgical approach.
See this image and copyright information in PMC

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