Benefits of Upper Medium Hemisternotomy in Aortic Valvular Surgery with Rapid Deployment Prosthesis

Abstract

Objective: Upper hemisternotomy in aortic valve surgery has been used for 20 years. Rapid deployment aortic prostheses facilitate the use of less invasive approaches and shorten surgical times. Our objective is to compare a series of patients who received the Edwards Intuity Rapid Deployment Aortic Prosthesis via hemisternotomy or full sternotomy. Methods: From September 2012 to December 2019, 109 patients with isolated severe aortic stenosis received the Edwards Intuity prosthesis (63% male, 75 ± 4.5 years). Results: Overall mortality was 2.8%, and 70% underwent surgery with upper hemisternotomy. This group had a greater baseline body surface area (1.86 ± 0.16 vs 1.8 ± 0.12; p = 0.048) and included more men (69% vs 48%; p = 0.042), but presented significantly shorter CPB time (58 ± 18 vs 68 ± 17 min; p = 0.006), less drainage in 24 h (315 ± 179 vs 468 ± 301; p = 0.001), lower rate of postoperative stroke (1.3 % vs 10%; p = 0.035), lower rate of packed red blood cell transfusions (45% vs 71%; p = 0.014), shorter stay in ICU (3 ± 8 vs 4 ± 7 days; p = 0.005) and hospital (10 ± 9 vs 14 ± 12 days; p = 0.001). There were no differences between the two groups in hospital mortality (2.6% vs 3.2%; p = 0.849), nor in the need for postoperative pacemaker (6.5% vs 6.5%; p = 0.994), nor in mortality at follow-up (12% vs 11.5%, p = 0.966). Conclusions: These results suggest that the benefits of upper mid hemisternotomy in aortic valve surgery exist even when using rapid deployment prostheses and would therefore be independent of the type of prosthesis implanted. Randomized studies are necessary to confirm these findings.