Complete Sternotomy Research Articles

Selecting the Access and Approach: Resect Versus Respect

Since the late 90s, minimally invasive mitral valve repair (MIMVR) has become a routine technique in cardiac surgery. It is generally defined as a small surgical chest wall incision, which does not involve a complete sternotomy. Using this approach, nearly every surgical technique for mitral valve repair that is performed via full sternotomy can and should also be performed using a mini access approach, as MIMV surgery does not mean accepting compromises.

A comparative study of minimally invasive aortic valve replacement with sutureless biological versus mechanical prostheses.

The ministernotomy approach with sutureless aortic bioprosthesis may provide an attractive and safe option for aortic valve disease patients. To assess the early and mid-term outcomes of minimally invasive aortic valve replacement (miniAVR) with sutureless vs. standard prostheses. The study involved 76 consecutive patients (51 males and 25 females) with mean age of 63.2 years who were treated with miniAVR between 2015 and 2022. They were divided into 2 subgroups: group I (n = 40) subjects with sutureless bioprostheses and group II (n = 36) with standard prostheses implanted. Early and mid-term outcomes were evaluated. A probability of survival was estimated by means of the Kaplan-Meier method. No conversion to complete sternotomy was necessary. The median (minimum; maximum) aorta cross clamping and cardio-pulmonary bypass times were 49 (27; 84) and 70 (40; 188) minutes in group I whereas 69 (50; 103) and 95 (69; 170) minutes in group II, respectively (p < 0.001). In-hospital mortality was 5.0% (n = 2) and 2.8% (n = 1) in group I vs. II, respectively (ns). Permanent ICD implantation was performed in 8 (20.0%) in group I and in 3 (8.3%) subjects in group II. In the discharge echocardiography, the function of all prostheses was correct. Five-year probability of survival was much lower in group I (0.75 ±0.10) than in group II (0.94 ±0.04). No wound infection or sternum instability was noted. Intraoperative advantages of miniAVR procedures for aortic valve patients with sutureless bioprostheses do not translate directly into improved early and middle-term outcomes.

Ministernotomy approach to aortic arch inclusion and frozen elephant trunk in the treatment of acute Stanford A aortic dissection.

This study aimed to report our results of ministernotomy approach to Liu’s aortic root repair technique, Liu’s aortic arch inclusion technique with frozen elephant trunk (FET) in the treatment in type A aortic dissection (TAAD). We retrospectively analyzed data on 68 Stanford A aortic dissection patients from October 2017 to March 2020. All patients underwent Liu’s aortic root repair technique, Liu’s aortic arch inclusion technique with FET and mild-moderate hypothermic circulatory arrest combined with ministernotomy approach. 154 TAAD patients between January 2014 and December 2016 underwent complete sternotomy were selected as control group. Clinical characteristics, data during operation, in-hospital and postoperative outcomes of these patients were observed. The mean hypothermic circulatory arrest time in ministernotomy Patients was 39.3 ± 7.9 min, aortic cross-clamp time was 105.9 ± 12.8 min, cardiopulmonary bypass time was 152.8 ± 24.3 min. Three patients died of multiple organ dysfunction syndrome in ministernotomy Patients. Perioperative temporary neurological dysfunction occurred in three (4.41%) patients, and 53 (77.9%) patients did not require any blood product transfusion during and after operation in ministernotomy Patients. Postoperative CT angiography (CTA) examination at 6-32 months showed excellent outcomes except in three (4.41%) cases where arch false lumen patency persisted. The Liu’s aortic root repair technique, Liu’s aortic arch inclusion technique with FET and mild-moderate hypothermia circulatory arrest simplify the surgical procedure and reduce bleeding, which can be accomplished through minimally invasive approach.

P51 HYBRYD TREATMENT FOR CORONARY ARTERY DISEASE CONCOMITANT WITH MINIMALLY INVASIVE CARDIAC VALVE SURGERY

Abstract Cardiac valvular surgery concomitant with coronary artery bypass grafting has a higher mortality than isolated valve surgery. Therefore, a hybrid approach that combines the benefits of the low risk of percutaneous coronary angioplasty (PCI) with those of minimally invasive valve surgery, should be considered. At present, data on hybrid valve/PCI procedures are limited to clinical cases and small cases, in which the PCI procedure is usually followed by surgery after about 3 weeks. We report our experience in which valve surgery was first performed with a minimally invasive approach (minithoracotomy or ministernotomy), then followed by coronary revascularization with PCI, to reduce the risks of post–surgical bleeding due to anti–aggregating therapy, in a non–randomized but consecutive case. Between July 2019 and June 2021, 22 patients were treated. Median of the days between surgery and PCI was 8, median of total hospitalization was 13 days. In 6 patients the surgical approach was a ministernotomy, in 16 was performed a right minithoracotomy. In 14 (64%) patients PCI was performed on single coronary vessel, in 5 (22.5%) on 2 coronary vessels and in 3 (13.5%) on 3 coronary vessels. There were no reinterventions for postoperative bleeding. One patient presented gastro–intestinal bleeding from a colon polyp. No patients died during hospitalization, nor at the follow–up performed by telephone every 6 months. No patients required valve reintervention or coronary artery bypass during hospitalization or follow–up. One patient underwent a new PCI procedure at 7 months. In conclusion, the hybrid approach consisting of minimally invasive valve surgery followed by PCI may offer an alternative to the standard but more complex operation of coronary artery bypass grafting plus valve surgery through complete sternotomy.

Outcomes of the Valve-Sparing Root Replacement Procedure with Partial Upper Sternotomy.

Due to better postoperative convalescence and quality of life, experienced centers focus on minimally invasive surgical techniques and approaches, but this approach is not routinely performed for valve-sparing root replacement procedures. The purpose of this study was to assess the safety and feasibility of valve-sparing root replacement via partial upper sternotomy. Between January 2016 and April 2021, 269 patients underwent a valve-sparing root replacement procedure, and partial upper sternotomy was performed in 52 patients. The clinical outcomes of the partial upper sternotomy (PUS) and complete sternotomy (CS) groups, including mortality, degree of aortic insufficiency, blood loss and consumption of blood products, postoperative complications, and hospitalization expenses, were compared. The Kaplan–Meier method was used to assess the degree of aortic regurgitation. Propensity score matching was performed as a sensitivity analysis. There was only one in-hospital death (in the CS group, p = 1) and no postoperative moderate to severe aortic insufficiency in either group. The blood loss and consumption of blood products in the PUS group were also lower than in the CS group, especially for plasma use. Regarding the need for re-exploration because of bleeding, acute kidney injury, pericardial pleural effusion, drainage volume within the first 24 h, mechanical ventilation time, and arrhythmia, the two groups were comparable. Patients in the CS group showed a longer ICU time (74.20 ± 47.21 vs. 50.9 30.16 h, p = 0.001) and higher hospitalization expenses (135,649.52 ± 29,992.21 vs. 123,380.15 ± 27,062.82 yuan, p < 0.001). None of the patients died or reoperated during the follow-up. Freedom from moderate or severe aortic insufficiency remained comparable after matching (p = 0.97). Minimally invasive valve-sparing aortic replacement via partial upper sternotomy can be safely performed in selected patients.

Safety and Efficiency of Mini-Sternotomy versus Standard Sternotomy in Open Heart Surgery for Aortic Valve Replacement

Background: For decades, the traditional median sternotomy has been the access of choice in aortic valve surgery; however, numerous researchers have worked to develop less invasive procedures, and the partial upper mini-sternotomy is the most prevalent minimally invasive procedure. Objective: To compare outcomes, in patients who undergo mini-sternotomy, and patients who undergo standard sternotomy, in aortic valve replacement operations. Patients and Methods: This randomized controlled clinical trial study included fifty patients who were admitted to the Zagazig University Hospital, Cardiothoracic Surgery Department in the period between January 2021 to August 2021, Patients were split into two groups, each with 25 patients: Group A had aortic valve surgery by mini-sternotomy, while Group B got aortic valve surgery via traditional surgery. Aortic valve surgery was performed via a conventional median sternotomy in Group B. An ECG was performed to see whether there was any ischemia present, as well as laboratory tests and a chest x-ray. Results: In the present research, there was a significant difference in postoperative outcomes between the mini-sternotomy and complete sternotomy groups in terms of mechanical ventilation and hospital stay. Inotropic support and reopening were not substantially different across groups; however, infection and blood transfusion were strongly linked with the complete group, and neither group had any mortality. Conclusions: Minimally invasive aortic valve replacement, is a safe and effective procedure and is performed with comparable morbidity and mortality to conventional aortic valve replacement (AVR). Minimally invasive aortic valve replacement (MIAVR) results in improved ventilator function, fewer wound infections, shorter hospital stays, and a higher percentage of patients released home early.

Minimally-invasive versus transcatheter aortic valve implantation: systematic review with meta-analysis of propensity-matched studies.

BackgroundMinimally invasive aortic valve replacement (MiAVR) and transcatheter aortic valve implantation (TAVI) provide aortic valve replacement (AVR) by less invasive methods than conventional surgical AVR, by avoiding complete sternotomy. This study directly compares and analyses the available evidence for early outcomes between these two AVR methods.MethodsElectronic databases were searched from inception until August 2019 for studies comparing MiAVR to TAVI, according to predefined search criteria. Propensity-matched studies with sufficient data were included in a meta-analysis.ResultsEight studies with 9,744 patients were included in the quantitative analysis. Analysis of risk-matched patients showed no difference in early mortality (RR 0.76, 95% CI, 0.37–1.54, P=0.44). MiAVR had a signal towards lower rate of postoperative stroke, although this did not reach statistical significance (OR 0.42, 95% CI, 0.13–1.29, P=0.13). MiAVR had significantly lower rates of new pacemaker (PPM) requirement (OR 0.29, 95% CI, 0.16–0.52, P<0.0001) and postoperative aortic insufficiency (AI) or paravalvular leak (PVL) (OR 0.05, 95% CI, 0.01–0.20, P<0.0001) compared to TAVI, (OR 0.42, 95% CI, 0.13–1.29, P=0.13), while acute kidney injury (AKI) was higher in MiAVR compared to TAVI (11.1% vs. 5.2%, OR 2.28, 95% CI, 1.25–4.16, P=0.007).ConclusionsIn patients of equivalent surgical risk scores, MiAVR may be performed with lower rates of postoperative PPM requirement and AI/PVL, higher rates of AKI and no statistical difference in postoperative stroke or short-term mortality, compared to TAVI. Further prospective trials are needed to validate these results.

R21 Aortic Valve Replacement Using Stented or Sutureless Prosthesis via Either Full-Sternotomy or a Minimally Invasive Approach: A Metwork Meta-analysis

In the era of transcatheter aortic valve replacement (TAVI), new technologies such as sutureless prosthetic valves and access via minimally-invasive incisions reduce surgical trauma for patients undergoing surgical aortic valve replacement (SAVR). Whether a reduction in cardiopulmonary bypass and aortic cross-clamp times or avoiding complete sternotomy offer improved early postoperative outcomes is unknown.

Results of Minimally Invasive Valve-Sparing Aortic Root Valve Surgery: Propensity Score Matching Analysis.

Aim Evaluation of efficacy and safety of minimally invasive, valve-sparing interventions on the aortic root and a comparative analysis of outcomes versus a group of patients with a complete sternotomy intervention using the method of propensity score matching (PSM).Materials and methods From 2016 through 2019, 458 interventions on the aortic root were performed, including 160 (36.6 %) interventions with mini-sternotomy. The study included 106 patients with the valve-sparing surgery (David procedure). Two groups of 30 patients each were formed using PSMC: group 1, complete sternotomy (CS) and group 2, J-shaped mini-sternotomy (MS). Immediate and long-term outcomes were evaluated at 13.8±10.3 (1-38 months (min-max) in the MS group and 42±21 (1-61 months (min-max) in the CS group.Results Statistically significant differences in death rate, echocardiographic indexes, absence of reoperations and complications in the postoperative period were not observed. In group 2, durations of extracorporeal circulation (p=0.04) and period of myocardial ischemia (p=0.004) were increased. The same group showed decreased intraoperative blood loss (p=0.001), postoperative drainage losses (p=0.0001), extubation time (р=0.0001), duration of stay in resuscitation and intensive care units and in the department of reconstructive recovery cardiovascular surgery (p=0,005).Conclusion The David procedure with mini-sternotomy is a safe and effective alternative to the traditional approach. This technique significantly reduces the time of rehabilitation and duration of patients' stay in the hospital without significant differences in the long-term period, which suggests advantages of this method. However, despite these promising results, the retrospective nature of this study, a small sample of patients, and a short follow-up period warrant further study.

Humongous mediastinal goiter: Interesting case report with its management challenges

Goiters with mediastinal extension are very rare. Occasionally they necessitate thoracic exploration for complete surgical excision which may be associated with serious complications. A 50-year-old man presented with a simple multinodular goiter and huge thoracic extension. After adequate investigative workup and optimal preoperative preparation, he underwent successful total thyroidectomy via combined cervicotomy and complete sternotomy. The excised goiter was 1.85 kg in weight and 20 × 25 × 18 cm in dimensions occupying entire anterosuperior mediastinum and 60% of left pleural cavity. Postoperative recovery was uneventful with no major morbidity. Rarely, giant thoracic extensions such as this case can be encountered. We are arguably reporting one of the largest thoracic goiters ever reported.

Mini-invasive Approach In Aortic Valve Replacement Results In Decreased Transfusional Requirement

Objective: Aortic Valve Replacement (AVR) is the most frequent valve surgery. Classically, it performed through complete sternotomy (CS). Recently, there is growing interest in minimally invasive approaches. Our aim is to compare both approaches in AVR surgery. Methods: We performed a retrospective analysis. Patients who underwent AVR between 2015-2017 were included. We excluded patients with previous cardiac surgery or combined procedures. The two approaches were: CS and Mini-Sternotomy (MS) performed by J type upper incision. The outcomes were: Extracorporeal Circulation Time (ECT), Cross Clamping Time (CCT), Mechanical Venitilation Time (MVT), Transfusion Requirement (TR), Hospital Stay (HS) and Operative Mortality (OM). The variables are expressed in percentages and mean ± standard deviation. For the comparison between groups Student’s T test was used for continuous variables and Chi2 for dichotomous variables, Alpha = 5%. Results: Ninety five patients were included in 3 years. Fifty five (58%) patients underwent CS and 40 (42%) MS. In 2015, 91% CS and 9% MS, 2016 50% CS and 50% MS, 2017 23% CS and 77% MS. The ECT was 85 ± 26min CS and 104 ± 26 MS (p = 0.003), CCT 60 ± 24min CS and 69 ± 16min MS (p = 0.037), MVT 11.7 ± 5.7hs CS and 11.5 ± 21hs MS (NS), TR 3.2 ± 1.9vol in CS and 2.2 ± 1.2vol MS (p = 0.036), HS 8.3 ± 4.4 days in CS and 8.6 ± 8.0 days MS (NS), OM 2/55 CS, 1/40 MS (NS). Conclusions: We present the results of AVR at our institution in the last three years. The use of MS has increased. MS requires higher ECT and CCT. However, this doesn´t imply higher HS, MVT or OM. The MS determines a significant reduction of TR. The minimally invasive approach in AVR constitutes a viable option reducing the transfusional burden.

Early Postoperative Outcomes for Aortic Valve Replacement Using Stented Versus Sutureless Valves Via a Full Sternotomy or Minimally Invasive Approach: A Network Meta-Analysis of Surgical Techniques

Purpose: In the era of transcatheter aortic valve replacement, new technologies such as sutureless prosthetic valves and improved access via minimally invasive incisions offer a reduction in surgical trauma for patients undergoing surgical aortic valve replacement. It remains unclear whether a reduction in cardiopulmonary bypass and aortic cross-clamp times, or avoiding complete sternotomy offer improved early postoperative outcomes. A network meta-analysis was performed to compare minimally invasive aortic valve replacement (MiAVR) with sutureless aortic valve replacement (SuAVR), and full sternotomy aortic valve replacement (FAVR).

Our experience with surgical minimally invasive aortic valve replacement

BackgroundIn the context of the development of modern cardiac valve interventional methods (TAVI, TMVI, MitraClip), miniinvasivity in cardiac surgery is becoming increasingly important. An alternative approach to complete sternotomy in isolated aortic valve replacement (AVR) is access from anterior thoracotomy or upper ministernotomy. In CKTCH Brno, is performed an isolated aortic valve replacement (AVR) from the upper hemisternotomy (UHS) from 2013 onwards. MethodsBetween 2013 and 2016, isolated AVR was perfomed in our institution 666 patients. Full median sternotomy approach was used in 565 patients, minimally invasive approach (UHS) in 101 patients. In the ministernotomy group, classical biological or mechanical prosthesis was implanted in 55 patients; in 46 patients we used rapid deployment (sutureless) bioprosthesis Sorin Perceval S. In our study we compare the results of full sternotomy a hemisternotomy approach and also describe our surgical technique of minimally invasive aortic valve replacement. ResultsWe registered gradual increase in minimally invasive AVR between 2013 and 2016 (9 patients in 2013, 59 patients in 2016). The combined hospitalization and 30-day mortality was 0.53% (3 patients) in the full sternotomy group and 0.99% (1 patient) in the ministernotomy group. In the most risky patients, we indicated ministernotomy with implantation of rapid deployment bioprosthesis (Euroscore II. 3,0 vs. 1,6 in the group of patients with full sternotomy AVR). As published, we confirmed longer aortic cross clamp time (AoX) and lenght of extracorporal circulation (ECC) in the patients with ministernotomy and implantation of sutured aortic prosthesis in comparison with full sternotomy AVR. Conversely, shorter AoX time and ECC time was observed in patients with rapid deployment prosthesis implantation from ministernotomy. We also recorded smaller postoperative blood loss in patients with ministernotomy apporach. The other monitored parameter were comparable. ConclusionIn this study we describe our technique and results of minimally invasive aortic valve replacement in our institution. Based on our results, we evaluate this technique as safe and well reproducible.

Propensity-matched comparison between minimally invasive and conventional sternotomy in aortic valve resuspension†

The aim of the study was to compare the results of David procedure through conventional or minimally invasive approach. A propensity-matched comparison in patients undergoing a minimally invasive (partial upper sternotomy, n = 103) or complete sternotomy (n = 103) David procedure from 1991 to 2016 was performed. Patients were 57 ± 14 years old on average in both groups. The David technique was modified by generating a neosinus (P < 0.01) in 99 (96%) patients (minimally invasive group) and in 42 (41%) patients (complete sternotomy group), respectively. The average follow-up time was 3 ± 2 years (minimally invasive group) and 8 ± 4 years (complete sternotomy group). There was only 1 in-hospital death (in the full sternotomy group, P = 0.5). The applied quantity of packed red blood cells (pRBC) was significantly higher in the complete sternotomy group (3.4 ± 4 vs 1 ± 0.5, P < 0.01). There were no late deaths in the minimally invasive group but 14 died during a longer follow-up period in the full sternotomy group (P < 0.01). Freedom from reoperation or aortic valve insufficiency ≥2° was 95% vs 93% (minimally invasive versus complete sternotomy group) at 5 years and 95% vs 79% at 10 years (P < 0.01). The minimally invasive aortic valve reimplantation procedure for selected patients with aortic root aneurysm and aortic valve incompetence is a durable procedure with minor valve-related morbidity and mortality at the mid-term follow-up. The intra- and perioperative application of pRBC was significantly lower in the minimally invasive group. However, comparison of long-term follow-up data in both groups is necessary to evaluate valve function.

Can more invasive procedures be avoided in patients with intrathoracic goitre? Patients with intrathoracic goitre and surgery

Objective: We aimed to evaluate whether patients require an incision other than the neck incision before thyroid surgery. Methods: We analysed data from 30 patients who underwent surgery for retrosternal goitre in our clinic between January 1996 and May 2017. We evaluated patient age, sex, physical examination findings, laboratory results, the surgical technique used, and complications. We used radiography, neck ultrasonography, and thoracic Computed Tomography (CT) to diagnose retrosternal goitre. All patients underwent fine-needle aspiration biopsy and those who were euthyroid underwent surgery. We examined postoperative morbidity, complications, and the duration of hospitalisation. Results: This study involved 30 patients (23 females, 7 males; average age, 44 y (range: 32-69 y)). One undiagnosed event appeared as an intrathoracic mass on thoracic CT; sternotomy was performed and postoperative examination revealed thyroid pathology. Three patients underwent surgery that began with a collar incision and involved complete sternotomy, and three patients underwent partial sternotomy. The duration of hospitalisation for patients in whom the collar incision was sufficient was about 3 d; in cases of partial sternotomy, it was 5 d. The duration of hospitalisation in cases of complete sternotomy was 5.2 d. Infection occurred in three patients and haemorrhage occurred in two patients in the neck incision area; there were no deaths. According to postoperative pathological examination, one patient had Hashimoto’s thyroiditis and all other patients had multinodular goitre. Conclusions: Median Sternotomy (MS) is not necessary in all cases of intrathoracic goitre that extend beyond the thoracic inlet. Thorough preoperative evaluation and good surgical planning are required to avoid unnecessary MS.

Midterm Results of a Minimally Invasive Approach in David Procedure.

The David procedure is a well-known technique in selected patients with aortic root pathology. A minimally invasive approach in heart surgery increases open interest. From 1991 to 2015, the David technique was performed in 296 patients in our unit. In 90 cases, operations were performed through partial upper sternotomy. The patient mean age was 57 ± 14 years in the minimally invasive group (n = 90) and 58 ± 14 years in the complete sternotomy group (n = 206; p = 0.2). The neosinus modification was performed in 80 patients (89%) in the minimally invasive group and in 79 patients (38%) in the complete sternotomy group (p < 0.01). Mean follow-up was 3 ± 2 years in the minimally invasive group and 8 ± 4 years in the complete sternotomy group. Thirty-day mortality was zero in the minimally invasive group and was 3% (n = 6) in the complete sternotomy group (p = 0.1). The need for packed red blood cells was significantly lower in the minimally invasive group (1.6 ± 3 U) than in the complete sternotomy group (3.7 ± 6 U; p < 0.01). Thirty late deaths (2% per patient-year) were observed in the complete sternotomy group versus zero in the minimally invasive group (p < 0.01). One patient (0.5% per patient-year) in the minimally invasive group and 12 patients (0.8% per patient-year) in the complete sternotomy group required reoperation in the follow-up period (p = 0.05). Minimally invasive David technique for patients with ascending aortic aneurysm and aortic valve insufficiency offers a good solution with low perioperative blood transfusion rate. Our midterm results show low valve-related complications and reoperation rate. However, long-term follow-up of the minimally invasive group is necessary.

Outcome variables of right anterolateral mini-thoracotomy versus complete sternotomy in atrial septal defect closure: A randomized controlled trial

BackgroundOver the last decades, atrial septal defect repair (ASD) as one of the most congenital anomalies has been customarily repaired via sternotomy incision. This technique is associated with very low operative risks and excellent outcomes but with poor esthetic results for the patients. Consequently, right anterolateral mini thoracotomy was invented as a substitute technique aiming for superior cosmetic results. Our study aim was to compare the perioperative outcomes for different approaches. MethodsForty patients (15 males, 25 females) with ASDs were randomly assigned to have either one of these two approaches at our institution from March 2013 until May 2016. The patients' ages ranged from 2 to 53 years old. Based on their randomization, group I (20 patients), had right anterolateral mini-thoracotomy (RALT) and group II (20 patients) who had sternotomy for surgical closure of ASD. We collected the different demographic, baseline, perioperative and postoperative characteristics. ResultsThe patients in both groups were similar in age preoperative comorbidities and ejection fraction but more females were in RALT group. There was a highly statistically significant prolonged pump-run time in the thoracotomy group than the sternotomy group with p-value = 0.004. Interestingly, in the thoracotomy group, mechanical ventilation time (hours) was shorter with p-value = 0.002. There were similar blood transfusion rate, chest tube drainage, intensive care unit stay and hospital length of stay. However, more wound infection was found in the sternotomy group which was statistically significant (p-value = 0.035). There were no patients requiring conversion to full sternotomy, no residual defect across the atrial septum and all patients were alive on a month follow-up of the hospital discharge. ConclusionsRight anterolateral mini-thoracotomy is safe, cosmetic, effective and technically feasible and not inferior to the formal median sternotomy to repair ASDs surgically.

Pain and the Quality of Life Following Robotic Assisted Minimally Invasive Surgery.

Minimally invasive bypass grafting is a promising surgical treatment in proximal LAD stenosis procedures. The main goal of this study was to make comparisons between robotically assisted minimally invasive coronary bypass surgery and conventional surgery in isolated proximal LAD lesions in terms of pain and quality of life improvement. The study contains patients with proximal LAD lesions who were treated with robotically assisted minimally invasive coronary artery bypass surgery and conventional bypass surgery between June 2005 and November 2012. Fifty patients treated with coronary bypass with cardiopulmonary bypass and complete sternotomy were categorized as Group 1. Fifty patients who applied for robotically assisted minimally invasive bypass surgery were categorized as Group 2. The evaluations of pain and quality of life were done according to the Verbal Rating Scale (VRS) and SF-36 health survey questionnaire, respectively. The conventional bypass group and robotic group had 4.8 ± 1.9 years and 4.3 ± 1.6 years mean follow-up time, respectively. The robotic bypass group had a significantly shorter ICU stay and hospital stay than the conventional bypass group (P &lt; .05). The pain score was higher in the robotic bypass group on the 1st postoperative day (P &lt; .05), but the score on the 4th postoperative day was higher in the conventional bypass group (P &lt; .05). In terms of domains of the SF-36 questionnaire, patient scores were significantly higher in patients who were operated with robotically assisted minimally invasive direct coronary artery bypass (MIDCAB) procedure than in patients who were operated with conventional bypass technique. Patients operated with robotically assisted MIDCAB procedure had results with lesser pain, shorter ICU stay, and shorter hospital stay than the other group in isolated proximal LAD stenosis. The same group also had better quality of life results according to the SF-36 questionnaire results.

Robotic mitral valve repair.

Mitral valve repair is the standard therapy for patients with severe mitral regurgitation. Currently, robotic mitral valve repair is the least invasive surgical approach and an alternative to the traditional sternotomy. Recent studies and newer guidelines on mitral valve repair advocate for earlier referral to surgery, resulting in better long-term outcomes of valve function and decreased left ventricular remodeling. Robotic mitral valve repair outcomes were compared with nonrobotic mitral repair outcomes through analysis of 4 recent studies, one of which was the Food and Drug Administration trial that granted approval of robotic cardiac surgery. Two studies included their own nonrobotic groups for comparison, with one comparing the robotic approach with complete sternotomy, partial sternotomy, and mini-anterolateral thoracotomy to assess all currently available techniques. All 4 studies showed positive outcomes including decreased need for postoperative mechanical ventilation, intensive care unit length of stay, and hospital length of stay. The studies also showed that postrepair mitral regurgitation was equivalent to that of traditional open repairs at multiple different periods after surgery. Patients should be given the option for minimally invasive robotic mitral valve repair if they have no other risk factors such as peripheral vascular disease that prevent femoral cannulation for cardiopulmonary bypass or the need for concomitant cardiac surgery such as coronary artery bypass. With the equality of robotic outcomes compared with full sternotomy valve surgery comes the need for more research into what kind of complex valve repairs can be done, which methods of repair work best with robotic techniques, whether the learning curve for robotic surgery can be shortened with more widespread use, and what outcomes can be improved upon from this standpoint. Healthcare professionals need to be aware of all choices for patients who need surgical intervention for their mitral regurgitation.

Sex-related differences in 2197 patients undergoing isolated surgical aortic valve replacement.

The aim of this study is to evaluate gender-related differences in clinical presentation and mortality in patients undergoing isolated surgical aortic valve replacement (SAVR). We performed a retrospective analysis of all patients undergoing isolated SAVR from 2000 to 2011 in our center. Patient data were compared with regard to gender including baseline characteristics, 30-day, and late mortality. Kaplan-Meier survival curves were used to analyze long-term survival up to 10 years follow-up. Independent risk factors for 30-day and late mortality were identified using a Cox regression model. Two thousand one hundred ninety-seven patients were included, 1290 (58.7%) male patients and 907 (41.3%) female patients. Female patients were older (70 ± 11 vs. 64 ± 13 years, p < 0.001), presented with higher logistic EuroSCORE (7.5 ± 5.8 vs. 5.6 ± 6%, p = 0.006), and more common NYHA class III or IV (71 vs. 65%, p = 0.05). Male patients presented more often with LV dysfunction (7.5 vs. 2.8%, p < 0.001) and endocarditis (4.1 vs. 1.7%, p < 0.001) than female patients. Intraoperatively, female patients were more likely to have had a complete sternotomy (65 vs. 52%, p < 0.001) and SAVR with a bioprosthesis (87 vs. 78%, p < 0.001). Female patients exhibited a higher 30-day mortality (4.4 vs. 1.6%, p < 0.001) and late mortality (13 vs. 9.6%, p = 0.04) than male patients. After adjustment for baseline characteristics, only female gender was an independent predictor for 30-day mortality (HR 2.2, 95% CI 0.98 to 5.2, p = 0.05) and age as independent predictor for late mortality (HR 1.07, 95% CI 1.03 to 1.1, p < 0.001). Female patients were older and sicker and may therefore exhibit higher 30-day and late mortality than male patients. Female gender per se was a predictor for 30-day but not for late mortality.