Reemplazo valvular aórtico a través de esternotomía parcial superior vs. esternotomía convencional media: análisis mediante índice de propensión

Abstract

ObjectiveTo analyse the results of aortic valve replacement (AVR) through partial upper sternotomy (PUS). MethodologyBetween January 2011 and December 2016, 507 patients underwent simple AVR: 306 through conventional median sternotomy (CMS) and 201 through PUS. The propensity score was used to compare the results of both techniques in 201 patient pairs. ResultsThe average age was 70±11.5 years. Sixty percent were men and 58% had aortic stenosis. The median EuroSCORE II was 1.58% (.99-2.46). The median time of ischaemia and extracorporeal circulation for PUS and CMS was 82 minutes (72-92) and 102 minutes (90-114), vs 66 minutes (55-75) and 87 minutes (75-101), respectively (P<.05). Patients with CMS presented with greater postoperative bleeding and need for blood product transfusion than patients with PUS (P<.05). There were no significant differences between the two groups in the incidence of major adverse cardiovascular and cerebrovascular events in the postoperative period. Hospital mortality rate was 3.7% (P>.05). Five-year survival rate was 83%. After surgery, 96% of the patients were in NYHA functional class I or II and had a mean EQ-5D® health index of .81, regardless of group. ConclusionsAVR by PUS is a safe technique with short-, medium- and long-term results comparable to CMS. It is associated with less postoperative bleeding and need for blood product transfusion, but with a longer duration of ischaemia and extracorporeal circulation.