Conventional Median Sternotomy Research Articles

Minimally Invasive Coronary Artery Bypass Grafting in a Low-Risk Asian Cohort: A Propensity-Score Matched Study.

Minimally invasive coronary artery bypass grafting (MICS CABG) offers a new paradigm in coronary revascularization. This study aims to compare the outcomes of MICS CABG with those of conventional median sternotomy CABG (MS CABG) within a growing minimally invasive cardiac surgical program in Singapore. Propensity matching produced 111 patient pairs who underwent MICS CABG or MS CABG between January 2009 and February 2020 at the National University Heart Centre, Singapore. Minimally invasive direct coronary artery bypass surgery patients were matched to single- or double-graft MS CABG patients (Group 1). Multivessel MICS CABG patients were matched to MS CABG patients with equal number of grafts (Group 2). Overall, MICS CABG patients experienced shorter postoperative length of stay (P<0.071). In Group 2, procedural duration (P<0.001) was longer among MICS CABG patients, but it did not translate to adverse postoperative events. Postoperative outcomes, including 30-day mortality, reopening for bleeding, new onset atrial fibrillation as well as neurological, pulmonary, renal, and infectious complications were comparable between MICS and MS CABG groups. MICS CABG is a safe and effective approach for surgical revascularization of coronary artery disease and trends toward a reduction in hospital stay.

Minimally invasive versus conventional methods for aortic root surgery: Choosing the right approach.

Partial upper sternotomy is preferred for isolated aortic valve replacement because of its optimal surgical visibility and favorable cosmetic outcomes; however, it is not commonly used for aortic root surgery, and the conventional median sternotomy is still the preferred method for most surgeons. We aimed to compare the safety and effectiveness of a minimally invasive approach (partial sternotomy [PS]) and conventional approach (median sternotomy [FS]) for aortic root surgery. Patients who underwent aortic root surgery at our hospital from 2016 to 2021 were retrospectively enrolled and divided into two groups. After propensity score matching, the conventional group included 156 patients and the minimally invasive group-57 patients. Bicuspid aortic valves were observed in 63 (40.4%) and 33 (57.9%) patients in the FS and PS groups, respectively. Valve-sparing surgery was performed on 69 (44.2%) and 30 (52.6%) patients in the FS and PS groups, respectively. The minimally invasive approach was beneficial in terms of blood loss during the first 24 h after surgery (p = 0.029) and postoperative blood transfusion (p = 0.023). The survival rates and freedom from reoperation or severe aortic regurgitation after the David procedure were comparable between the standard and minimally invasive groups (p = 0.25; p = 0.66) at mid-term follow-up. A minimally invasive approach for aortic root surgery can be safely performed as the standard approach. Partial upper sternotomy has the advantage of lower blood loss in the early postoperative period and does not negatively affect the results of valve-sparing root replacement.

Postoperative quality of life and pain after upper hemisternotomy and conventional median sternotomy for aortic valve replacement: results of a randomized clinical trial.

Surgical aortic valve replacement through conventional sternotomy yields excellent results. Minimally invasive techniques are deemed equally safe and serve as a viable and less traumatic alternative. However, it is unclear how both surgical techniques affect patient-reported outcomes. The objective of this trial is to compare postoperative cardiac-related quality of life and postoperative pain after upper hemisternotomy and conventional surgical aortic valve replacement. In this single-centre, open-label, investigator-initiated randomized clinical trial, patients were randomized to upper hemisternotomy or conventional full median sternotomy. Patients unable to undergo randomization were monitored prospectively (registry group). Primary outcome was cardiac-specific quality of life, measured with the Kansas City Cardiomyopathy Questionnaire up to 1 year postoperatively. Patients undergoing upper hemisternotomy had a significantly higher physical limitation domain score across all postoperative time points than patients undergoing conventional surgical aortic valve replacement (estimated mean difference 2.12 points; P = 0.014). Patients undergoing upper hemisternotomy were more likely to have a pain score <30 the first 2 days postoperatively than patients undergoing conventional surgical aortic valve replacement (odds ratio 2.63; P = 0.007). This was associated with reduced opioid analgesic intake. Postoperative surgical outcome did not differ between both groups. Surgical aortic valve replacement through both conventional sternotomy and upper hemisternotomy resulted in clinically similar and important improvements in quality of life, with a small advantage for upper hemisternotomy, while there was no compromise in safety.

Right Ventricular Contractility and Pulmonary Arterial Coupling After Less Invasive Left Ventricular Assist Device Implantation.

Right ventricular failure contributes significantly to morbidity and mortality after left ventricular assist device implantation. Recent data suggest a less invasive strategy (LIS) via thoracotomy may be associated with less right ventricular failure than conventional median sternotomy (CMS). However, the impact of these approaches on load-independent right ventricular (RV) contractility and RV-pulmonary arterial (RV-PA) coupling remains uncertain. We hypothesized that the LIS approach would be associated with preserved RV contractility and improved RV-PA coupling compared with CMS. We performed a retrospective study of patients who underwent durable, centrifugal left ventricular assist device implantation and had paired hemodynamic assessments before and after implantation. RV contractility (end-systolic elastance [Ees]), RV afterload (pulmonary effective arterial elastance [Ea]), and RV-PA coupling (Ees/Ea) were determined using digitized RV pressure waveforms. Forty-two CMS and 21 LIS patients were identified. Preimplant measures of Ees, Ea, and Ees/Ea were similar between groups. After implantation, Ees declined significantly in the CMS group (0.60-0.40, p = 0.008) but not in the LIS group (0.67-0.58, p = 0.28). Coupling (Ees/Ea) was unchanged in CMS group (0.54-0.59, p = 0.80) but improved significantly in the LIS group (0.58-0.71, p = 0.008). LIS implantation techniques may better preserve RV contractility and improve RV-PA coupling compared with CMS.

Effect of minimally invasive cardiac surgery compared with conventional surgery on post-operative physical activity and rehabilitation in patients with valvular heart disease

BackgroundMinimally invasive cardiac surgery (MICS) has steadily become more and more popular. MICS is less invasive and has a faster return to normality after surgery. Patients who had MICS continue to exercise more frequently than those who had the conventional median sternotomy surgery. It is generally established that physical activity lowers mortality and the risk of cardiac disease. The purpose of the study: is to evaluate and compare physical activity levels in MICS and conventional surgery.ResultThe level of preoperative physical activity did not significantly differ between the two groups. However, the MICS group significantly exceeded the conventional group in terms of postoperative progress, amount of physical activity, and 6-minute walking test. Also, Visual Analog Scale (VAS) score was significantly less.ConclusionMinimally invasive cardiac surgery has a higher margin of benefit, and speedy recovery to normality, which is accompanied by a lower VAS score and increased physical activity in comparison to conventional surgery.

Mitral Valve Surgery by Right Minithoracotomy Vs Traditional Median Full Sternotomy

Objective: To compare the clinical outcomes of mitral valve surgery through right minithoracotomy versus median full sternotomy. &#x0D; Study Design: It was a comparative cross-sectional study&#x0D; Place and Duration of Study: Carried out at the Armed Forces Institute of Cardiology/National Institute of Heart Diseases(AFIC/ NIHD). Data was gathered from hospital database from Dec 2013 to Mar 2020.&#x0D; Methodology: From December 2013 to March 2020, 721 patients with various mitral valve diseases were treated at our institute with isolated mitral valve surgery. 50 patients had (MIMVS). 670 patients, on the other hand, underwent conventional median full sternotomy (MFS) mitral valve surgery. We selected 50 MFS patients with similar age, gender, Euro Score, NYHA functional class, Left ventricular ejection fraction (LVEF), mitral valve disease grade, renal and liver function. The outcome variables chosen for this study were cross clamp time (CXT), cardio pulmonary bypass (CPB) time, intensive care unit (ICU) stay, postoperative pain, and Length of stay (LOS).&#x0D; Results: The majority (n=42, 84%) of MIMVS group patients had CPB time between 122-201 minutes, whereas, majority (n=33,66%) of MFS group had CPB time between 81-134 minutes. In MIMVS group maximum number of the patients (n=36,72%)had ICU stay of 50-70 hours duration, whereas, in MFS group, maximum number of patients (n=40,80%) stayed in ICU for 10-30 hours duration. The mean CX time for MFS approach was 72.08 minutes while that for MIMVS was 96.9 minutes. Similarly,the median and mode for MFS were 68.5 minutes and 47 minutes respectively. Pain after surgery plus subsequent overall hospital length of stay (LOS) were reduced in MIMVS group.&#x0D; Conclusions: MIMVS is related with elevated CPB and CXT, which subsequently resulted in longer ICU stay while reduced post-operative pain lead to decrease in overall hospital length of stay.

State-of-the-Art Review: Technical and Imaging Considerations in Novel Transapical and Port-Access Mitral Valve Chordal Repair for Degenerative Mitral Regurgitation.

Degenerative mitral regurgitation (DMR) based on posterior leaflet prolapse is the most frequent type of organic mitral valve disease and has proven to be durably repairable in most cases by chordal repair techniques either by conventional median sternotomy or by less invasive approaches both utilizing extracorporeal circulation and cardioplegic myocardial arrest. Recently, several novel transapical chordal repair techniques specifically targeting the posterior leaflet have been developed as a far less invasive and beating heart (off-pump) alternative to port-access mitral repair. In order to perform a safe and effective minimally invasive mitral chordal repair, thorough knowledge of the anatomy of the mitral valve apparatus and adequate use of multimodality imaging both pre- and intraoperatively are fundamental. In addition, comprehensive understanding of the available novel devices, their delivery systems and the individual procedural steps are required.

A comparative study between mini versus full sternotomy aortic valve replacement

BackgroundAortic valve replacement for treatment of aortic valve diseases is quite common. Minimally invasive procedures have gained a lot of popularity in recent years with the claimed better early postoperative outcomes in comparison with conventional techniques.ObjectiveThe aim was to compare early postoperative outcomes after ministernotomy versus conventional median sternotomy aortic valve replacement.Patients and methodsThe authors prospectively studied 60 patients who underwent aortic valve replacement surgery at the National Heart Institute between the period of May 2020 and July 2021. A total of 30 patients had aortic valve replacement via upper ministernotomy approach, whereas the other 30 patients had aortic valve replacement using conventional median sternotomy. Early postoperative results were compared with each other.ResultsThere was no morality throughout the study. The mean age was 45.8 ± 15.13 years in the conventional group and 51.13 ± 17.8 in the ministernotomy group. Perioperative data showed no significant difference between the two groups, except for aortic orifice (root) diameter, which was wider in the ministernotomy group. The cross-clamp time was 60.33 ± 8.27 in the conventional group and 70.66 ± 6.91 in the ministernotomy group, and the total bypass time was 77.0 ± 8.46 and 88.1 ± 9.55, respectively, with significant difference between the two groups. Postoperative pain levels showed a statistically significant difference and were less severe in the ministernotomy group, and the total hospital stay was shorter in the ministernotomy group, with significant difference between the two groups.ConclusionThe use of upper ministernotomy approach to replace a diseased aortic valve is safe and can be compared with the conventional median sternotomy approach.

Comparative study between minimally invasive right anterior mini-thoracotomy versus conventional median sternotomy in isolated aortic valve replacement: early outcome

BackgroundIn cardiac surgery, minimally invasive surgical procedures have recently been adopted. These innovative procedures have a number of benefits, including less postoperative discomfort, fewer morbidity and mortality, faster recovery, and shorter hospital stays at lower costs.Patients and methodsOutcomes of 30 patients who underwent isolated aortic valve replacement, were subjected to a prospective comparative study, were compared. In group A (n = 15) minimally invasive right anterior mini-thoracotomy approach and in group B (n = 15) conventional median sternotomy approach had been used.ResultsThe second group had much higher total morbidity than the first. In group A, blood loss was 335.3 ± 174.5, while in group B, it was 633.3 ± 179.9. In group B, postoperative discomfort was much higher. In both groups, inotropes were determined to be negligible. Group B had a longer total hospital stay (101.7 days) than group A (5.60.6 days).ConclusionIn patients undergoing isolated aortic valve replacement, a right anterior mini-thoracotomy lowers postoperative pain, the requirement for blood transfusions, assisted ventilation time, and hospital stay.

Conventional Median Sternotomy Compared to the Percutaneous Transcatheter Device Closure for Secundum Atrial Septal Defect

Conventional Median Sternotomy Compared to the Percutaneous Transcatheter Device Closure for Secundum Atrial Septal Defect

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

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.

Surgical outcomes of minimally invasive aortic valve replacement via right mini-thoracotomy for hemodialysis patients.

Minimally invasive valve surgery has become increasingly accepted as an alternative to conventional median sternotomy in low-risk patients. However, there have been no reports regarding the outcomes of this procedure on high-risk hemodialysis patients. The purpose of this investigation was to assess the surgical outcomes of minimally invasive aortic valve replacement (AVR) via right mini-thoracotomy (MIAVR) in hemodialysis patients compared with those of conventional AVR (CAVR) via full sternotomy. Two hundred and seventy-four patients underwent isolated AVR for severe AS, and 42 hemodialysis patients were included in this study. MIAVR was performed in 17 cases and CAVR in 25 cases. We compared the short-term surgical outcome among the two groups. There was no difference in the aortic cross-clamp or cardiopulmonary bypass time. However, the procedure time was significantly shorter in the MIAVR group. Patients in the MIAVR group had less bleeding and a smaller amount of transfused red blood cells. There were four hospital deaths (18.2%) in the CAVR group. For postoperative complications, there were 2 (9.1%) cerebrovascular incidents, 2 (9.1%) cases of respiratory failure, 1 (4.5%) re-exploration for bleeding in CAVR group. The postoperative ventilation time was significantly shorter in the MIAVR group. There was no difference in the length of postoperative intensive care unit stay or of postoperative hospital stay. The surgical outcomes of MIAVR in hemodialysis patients were acceptable, with a low incidence of morbidity, reasonable lengths of hospital stay, and no mortality among the patients studied.

Comparison of the safety and efficacy between minimally invasive cardiac surgery and median sternotomy in a low-risk mixed Asian population in Singapore.

Minimally invasive cardiac surgery (MICS) has attracted increasing attention, with institutions increasingly adopting this approach over conventional median sternotomy (MS). This study aimed to describe the outcomes of minimally invasive cardiac surgery in our institution as the only centre with an established MICS programme in Singapore. Patients who had undergone cardiac procedures such as heart valve replacement or repair, coronary artery bypass grafting or atrial septal defect repair were included in the study. We analysed 4063 patients who had undergone MS and 390 patients who had undergone MICS between January 2009 and February 2020. Over the years, the number of MICS procedures performed increased, along with an increase in MICS operations with two or more concomitant cardiac procedures and a decrease in postoperative length of stay. Compared with patients who underwent MS, those who underwent MICS had shorter length of postoperative hospital stay (P < 0.001). On multivariate analysis, patients who underwent MICS had lower rates of atrial fibrillation (P = 0.021), reoperation (P = 0.028) and prolonged ventilation (P < 0.001). However, the rates of other postoperative complications were comparable between patients who underwent MICS and those who underwent MS. In our institution, MICS is a safe, reproducible and efficacious technique that yields superior outcomes compared with conventional MS procedures, in some aspects. The results of this study provide further evidence and support towards adopting the minimally invasive approach to cardiac surgery in a carefully selected group of cardiac patients in Singapore.

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 mitral valve repair for degenerative etiology: a comparative study

BackgroundThere is a paucity of data comparing the minimally invasive mitral valve repair (MiMVr) to the conventional approach in patients with degenerative disease. Our objective was to compare the outcomes of MiMVr to the traditional mitral valve repair through median sternotomy in patients with degenerative mitral valve disease. We conducted a retrospective study on 215 patients classified into two groups. Group 1 (n = 80) included those who had mitral valve repair through a right anterolateral video-assisted mini-thoracotomy, and group 2 (n = 135) was approached through a conventional median sternotomy. We compared the preoperative, operative, and postoperative data between groups. Both groups had echocardiographic follow-ups after 6 and 12 months.ResultsThere was no difference in gender distribution between both groups, and patients who had median sternotomy were significantly older (median 37 (Q1-Q3, 29-44) vs. 54 (48-60) years; P < 0.001). Cardiopulmonary bypass (134.5 (130-138.5) vs. 99 (97-104) min; P < 0.001) and ischemic times (99 (95-105.5) vs. 78 (75-81) min; P < 0.001) were significantly shorter in patients who had median sternotomy. Patients with MiMVr had significantly lower blood loss (370 (315-390) vs. 550 (490-600) ml; P < 0.001) and ICU stay (5 (4.5-6) vs. 7 (7-8) days; P < 0.001). There was no difference between both groups regarding re-exploration for bleeding, postoperative stroke, wound infection, renal failure, and mortality. As regards postoperative echocardiography follow-up at 6 and 12 months after the operation, there were no significant changes in the mean mitral valve gradient within each group; however, the mean gradient was lower in the MiMVr group (3 (3-3.5) vs. 4 (3-5) mmHg; P < 0.001). There was no significant difference between both groups regarding mitral regurgitation severity during 6 and 12 months follow-up.ConclusionMinimally invasive mitral valve repair in patients with degenerative pathology could be an alternative to conventional mitral valve surgery with comparable short-term and long-term outcomes.

Less invasive surgical implant strategy and right heart failure after LVAD implantation

Conventional median sternotomy (CMS) is still the standard technique utilized to implant left ventricular assist devices (LVADs). Recent studies suggest that less invasive surgery (LIS) may be beneficial; however, robust data on differences in right heart failure (RHF) are lacking. This study aimed to determine the impact of LIS compared with that of CMS on RHF outcomes after LVAD implantation. An international multicenter retrospective cohort study was conducted across 5 centers. Patients were grouped according to their implantation technique (LIS vs CMS). Only centrifugal devices were included. RHF was defined as severe or severe acute RHF according to the 2013 Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) definition. Logistic multivariate regression and propensity score‒matched analyses were performed to account for confounding. Overall, 427 implantations occurred during the study period, with 305 patients implanted using CMS and 122 using LIS. Pre-operative extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP) use was more common in the CMS group; off-pump implantation was more common in the LIS group. Other pre-implant variables, including age, creatinine, hemodynamics, and tricuspid regurgitation, did not differ between the 2 groups. Post-operative RHF was less common in the patients who underwent LIS than in those who underwent CMS as was post-operative right ventricular assist device (RVAD) use. LIS remained associated with less RHF in the multivariate analysis. After propensity score matching conditional for age, sex, INTERMACS profile, ECMO, and IABP use in a ratio of 2:1 (CMS to LIS), RHF (29.9% vs 18.6%, p = 0.001) and the need for post-operative RVAD (18.6% vs 8.2%; p = 0.009) remained more common in the CMS group than in the LIS group. There were no significant differences in survival up to 1 year between the groups. LIS may be associated with less RHF after LVAD implantation compared with CMS. Despite the possible reduction in RHF, there was no difference in 1-year survival. LIS is an alternative to traditional CMS.

Mini-sternotomy versus conventional sternotomy for aortic valve replacement: a randomised controlled trial

ObjectiveTo compare clinical and health economic outcomes after manubrium-limited mini-sternotomy (intervention) and conventional median sternotomy (usual care).DesignA single-blind, randomised controlled trial.SettingSingle centre UK National Health Service tertiary hospital.ParticipantsAdult patients undergoing...

Is tri-port totally thoracoscopic surgery for mitral valve replacement a feasible approach?

Minimally invasive cardiac surgery is an attractive approach for both surgeons and patients. This study aims to describe the experience of mitral valve replacement (MVR) with Ma's tri-port totally thoracoscopic cardiac surgery technique (MTCST) and to prove the feasibility and safety of this technique. A total of 490 consecutive patients undergoing MVR were divided into MTCST group (MT group, n=267) and conventional median sternotomy group (MS group, n=223). The perioperative characteristics and the follow-up information were recorded and analyzed between the two groups. The in-hospital mortality and re-operation rate were not significant between the two groups. Compared with the MS group, cardiopulmonary bypass time and aortic cross-clamp time were both longer in the MT group while total operative time was similar to the MS group. Patients in the MT group had less pain and required a decreased analgesic administration than that in the MS group. Intraoperative blood loss, perioperative blood transfusion and the postoperative drainage were all significantly reduced in the MT group as compared to the MS group. Mechanical ventilation time, ICU duration, hospitalization time and hospitalization cost were decreased in the MT group. Patients undergoing MVR with MTCST had a higher Medical Treatment Satisfactory Score than those with conventional sternotomy. MTCST for mitral valve disease was technically safe and feasible. The results showed that MTCST was a suitable minimally invasive alternative to the conventional sternotomy approach and was a desirable approach for patients with mitral valve disease.

Review of transapical off-pump mitral valve intervention with NeoChord implantation.

Mitral valve repair surgery has recently shifted from resection-based techniques to leaflet sparing approaches using synthetic neochordae. This has facilitated the growth of a new strategy of transapical off-pump mitral valve intervention with neochord implantation. Minimally invasive approaches for mitral valve repair with robotic or video-assisted mini-right anterolateral thoracotomy have been developed to mitigate the morbidity associated with conventional median sternotomy. Recently, an alternative, less invasive surgical strategy has emerged. This transapical off-pump technique employs the NeoChord DS1000 (NeoChord, Inc., Minneapolis, MN, USA) system to achieve repair with neochordae via a left minithoracotomy incision. With appropriate patient selection, advanced cardiac imaging, and training in device deployment are important for procedural success. Early results suggest that transapical off-pump mitral valve intervention with NeoChord implantation is a safe procedure with favorable outcomes for select patients with degenerative mitral regurgitation. Continued experience and clinical trials will assess the potential of this minimally invasive strategy, but this technique is likely to become part of the surgical repertoire for managing chronic degenerative mitral valve disease.

The Effect of Minimally Invasive Surgery and Sternotomy on Physical Activity and Quality of Life

The aim of this study was to compare minimally invasive surgery (MI) and median sternotomy (MS) in terms of post-procedure health-related quality of life (HRQoL) and functional outcome. We conducted a multicentre prospective cohort study that enrolled patients from January 2015 until February 2017. Combined cardiac procedures were performed with MS and isolated valve procedures with either MS or MI, depending on patient preference and surgeon experience. HRQoL was measured using the five-level version of the EQ-5D (EQ-5D-5L) and physical activity before and after surgery was evaluated using a wearable accelerometer. Activity patterns and intensity recorded by the accelerometer in each period were classified as "sedentary", "light physical activity", "moderate physical activity", and "vigorous physical activity" for each patient. We also conducted a sub-analysis of frail patients in each group, as identified by the Reported Edmonton Frail Scale (>10 points). Patients were followed for 1 year. The study included 100 consecutive patients who underwent MI (n=50) or MS (n=50) during the study period. Patients in the MI group showed a faster recovery of physical activity in the immediate postoperative period and superior HRQoL in the first 3 months (both p<0.001) versus the MS group. Differences between the MI and MS group were indistinguishable over a longer follow-up. A similar correlation was observed in the frailty subanalysis. Overall, the MS group had a higher cumulative incidence of events than the MI group (p<0.001). Compared to conventional MS, MI was associated with better HRQoL and early functional outcome, even in frail patients.