The Efficacy and Outcome of Ministernotomy Compared to Those of Standard Sternotomy for Aortic Valve Replacement

Abstract

Background. Benefits of ministernotomy have been reported but not yet fully established in the current literature. Ministernotomy may be associated with less bleeding, less need for transfusion, and reduced hospital length of stay. Methods. We retrospectively evaluated 347 patients who underwent aortic valve replacement between 2007 and 2011 at our institution. Results. Standard sternotomy was performed in 303 patients (154 males, 50.8% and 149 females, 49.2%) and ministernotomy in 44 patients (13 males, 30% and 30 females, 70%); most of the patients in ministernotomy group were female (75%) (P=.0095). The mean age for ministernotomy patients was 71.8±12.6 years and for sternotomy patients 67.4±13.8 years (P=.045). Significant preoperative morbidities (for ministernotomy and sternotomy, resp.) included stroke (11%, n=5 versus 18%, n=55; P=.39), PVD (23%, n=10 versus 16%, n=49; P=.29), COPD (25%, n=11 versus 17%, n=52; P=.21), renal failure (0.0%, n=0 versus 8.8%, n=26; P=.06), and previous heart surgery (9%, n=4 versus 9.5%, n=29; P=1.0). Intraoperative blood transfusion was required in 23% of ministernotomy patients (n=9) and 30% of sternotomy patients (n=91), P=.16. Major postoperative complications (for ministernotomy and sternotomy, resp.) included exploration for bleeding (4.5%, n=2 versus 6%, n=18; P=1) and adverse neurologic events (4.5%, n=2 versus 1.6%, n=5; P=.05). The length of stay (LOS) in the CCU was 75.4±57.1 hours for the ministernotomy group and 125.4±160.3 hours for the sternotomy group (P=.12). The LOS was slightly shorter following ministernotomy (9.00±7.78 days) compared to sternotomy (10.0±9.46 days) (P=.31). Perioperative mortality was 2.3% (n=1) for ministernotomy and 3.3% (n=10) for sternotomy (P=1.0). The 1-, 3-, and 7-year survival following ministernotomy was 93.8%, 93.8%, and 88.3%, respectively; following sternotomy, these rates were 87.7%, 83.7%, and 82.6%, respectively (95% CI 0.273 to 1.325, P=.20). Conclusion. Ministernotomy is less invasive and is associated with less perioperative and postoperative bleeding and reduced LOS in CCU and in hospital.