Minimally Invasive Aortic Valve Replacement with Partial Lower Sternotomy

Keisuke Morimoto,Futoshi Kobayashi,Shigeto Miyasaka,Suguru Shiraya

doi:10.4236/wjcs.2018.86009

Keisuke Morimoto, Futoshi Kobayashi + Show 2 more

Open Access

https://doi.org/10.4236/wjcs.2018.86009

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Abstract

Objectives: Due to recent spread of minimally invasive surgery, the demand for minimally invasive cardiac surgery (MICS) is increasing. We investigate the usefulness of minimally invasive aortic valve replacement (MICS-AVR) which was performed in our hospital. Methods: Of 63 consecutive patients undergone an isolated aortic valve replacement (AVR), 16 patients underwent MICS-AVR with partial lower sternotomy (M group) and 47 patients underwent AVR with median full sternotomy (C group). We compared the two groups in a retrospective study. Results: No significant difference was found in the surgical and perioperative-related factors between the two groups. However, the average of aortic cross-clamping time was longer, and intensive and high care unit stay was shorter in the M group. A tendency to decrease blood transfusion was observed in the M group. There was no hospital death in all patients. The mean follow-up period was 29 ± 15 months. There was no significant difference between the two groups in the survival rate, and the 5-year survival rates were 88.9% in the M group and 85.9% in the C group. Conclusion: It was suggested that the MICS-AVR could be safe and useful procedure in AVR.

Highlights

Aortic valve replacement (AVR) as a surgical treatment for aortic valve disease has been performed for many years by the median sternotomy approach
We investigate the usefulness of minimally invasive aortic valve replacement (MICS-AVR) which was performed in our hospital
There were no significant differences between the two groups in New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF) and serum Cr value

Summary

Introduction

Aortic valve replacement (AVR) as a surgical treatment for aortic valve disease has been performed for many years by the median sternotomy approach. The surgical technique with a right parasternal incision was reported as the first minimally invasive aortic valve replacement (MICS-AVR) performed by Cosgrove et al in 1996 [1]. Due to the recent spread of minimally invasive surgical operations and the progress of surgical instruments, the demand for MICS is increasing. Some surgical approaches have been performed for MICS-AVR, and the approach with a partial upper sternotomy [2] is commonly used. We have started MICS for cardiac valve diseases since 2010 in our hospital, and we have adopted an approach via a partial lower sternotomy. We investigated MICS-AVR with the partial lower sternotomy which was performed in our hospital

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