Abstract
BackgroundThe small incisions of minimally invasive surgery have the proposed benefit of less surgical trauma, less pain, and faster recovery. This study was done to compare minimally invasive techniques for aortic valve replacement, including right anterior mini-thoracotomy and mini-sternotomy, to conventional sternotomy.MethodsWe retrospectively reviewed 503 patients who underwent isolated aortic valve replacement at our institution from 2012 to 2015 using one of three techniques: 1) Mini-thoracotomy, 2) Mini-sternotomy, 3) Conventional sternotomy. Demographics, operative morbidity, mortality, and postoperative complications were compared.ResultsOf the 503 cases, 267 (53.1%) were mini-thoracotomy, 120 (23.8%) were mini-sternotomy, and 116 (23.1%) were conventional sternotomy. Mini-thoracotomy patients, compared to mini-sternotomy and conventional sternotomy, had significantly shorter bypass times [82 (IQ 67–113) minutes; vs. 117 (93.5–139.5); vs. 102.5 (85.5–132.5), respectively (p < 0.0001)], a lower incidence of prolonged ventilator support [3.75% vs. 9.17 and 12.9%, respectively (p = 0.0034)], and required significantly shorter ICU and postoperative stays, resulting in an overall shorter hospitalization [6 (IQ 5–9) days; vs. 7 (5–14.5); vs 9 (6–15.5), respectively (p < 0.05)]. Incidence of other postoperative complications were lower in the mini-thoracotomy group compared to mini-sternotomy and conventional sternotomy, without significance. Minimally invasive techniques trended towards better survival [mini-thoracotomy 1.5%, mini-sternotomy 1.67%, and conventional sternotomy 5.17% (p = 0.13)].ConclusionsMinimally invasive aortic valve replacement approaches are safe, effective alternatives to conventional sternotomy. The mini-thoracotomy approach showed decreased operative times, decreased lengths of stay, decreased incidence of prolonged ventilator time, and a trend towards lower mortality when compared to mini-sternotomy and conventional sternotomy.
Highlights
The small incisions of minimally invasive surgery have the proposed benefit of less surgical trauma, less pain, and faster recovery
If there is a contraindication to mini-thoracotomy due to anatomical reasons or body habitus, mini-sternotomy or full sternotomy is the second choice within our practice
There were 16 patients converted to conventional sternotomy (CS) to facilitate increased visibility and access, including 10 (3.75%) in the mini-thoracotomy (MT) group, and 6 (5.0%) in the mini-sternotomy (MS) group (Table 2); the difference was not statistically significant (p = 0.57)
Summary
The small incisions of minimally invasive surgery have the proposed benefit of less surgical trauma, less pain, and faster recovery. This study was done to compare minimally invasive techniques for aortic valve replacement, including right anterior mini-thoracotomy and mini-sternotomy, to conventional sternotomy. Since the late 1990s, minimally invasive techniques for aortic valve surgery, including mini-sternotomy and anterior mini-thoracotomy, have been gaining acceptance [2]. The small incisions of minimally invasive surgery have the proposed benefit of less surgical trauma, leading to less postoperative bleeding, fewer blood transfusions, and a decreased incidence of deep sternal wound infections [1, 3, 9, 10]. In this study we compare outcomes and perioperative variables after minimally invasive aortic valve replacements, via a mini sternotomy or an anterior thoracotomy approach, in comparison to outcomes after conventional sternotomy
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