Ministernotomy For Aortic Valve Replacement Research Articles

Ministernotomy for aortic valve replacement. Results in the diabetic patient

Introduction: aortic valve stenosis (AS), emerges as a new epidemic due to the aging population.Published data relate diabetes mellitus to risk factors involved in the pathogenesis of atherosclerosis. Objectives: to describe the results of aortic valve replacement by ministernotomy in diabetic patients. Methods: an analytical prospective cohort study was carried out on patients with aortic stenosis and diabetes mellitus treated at the Abel Santamaría Hospital and the Hermanos Ameijeiras Hospital from August 2016 to December 2021, the sample included 16 patients. Clinical and postoperative variables were used. Results: 66,7 % of the patients with aortic stenosis had a history of diabetes mellitus. Of these diabetics, 68,8 % were type 2 and only 31,2 % were type 1. Several post-surgical complications were listed and respiratory infections predominated with 12,5 %. Conclusions: Dyslipidemias and diabetes constitute atherogenic risk factors associated with aortic stenosis. Type 1 diabetes is the most frequently associated with aortic stenosis. The predominant symptoms independent of the type of diabetes were dyspnea and angina, and the predominant post-surgical complication was respiratory infections.

Comparative effects of minimally invasive approaches vs. conventional for obese patients undergoing aortic valve replacement: a systematic review and network meta-analysis

BackgroundMinimally invasive approaches like mini-thoracotomy and mini-sternotomy for Aortic Valve Replacement (AVR) showed impressive outcomes. However, their advantages for obese patients are questionable. We aimed in this network meta-analysis to compare three surgical approaches: Full sternotomy (FS), Mini-sternotomy (MS), and Mini-thoracotomy (MT) for obese patients undergoing AVR.MethodsWe followed the PRISMA extension for this network meta-analysis. PubMed/Medline, Scopus, Web of Science, and Cochrane searched through March 2023 for relevant articles. The analysis was performed using R version 4.2.3.ResultsOut of 344, 8 articles met the criteria with 1392 patients. The main outcomes assessed were perioperative mortality, re-exploration, atrial fibrillation, renal failure, ICU stay, hospital stay, cross-clamp time, and bypass time. In favor of MS, the length of ICU stay and hospital stay was significantly lower than for FS [MD -0.84, 95%CI (-1.26; -0.43)], and [MD -2.56, 95%CI (-3.90; -1.22)], respectively. Regarding peri-operative mortality, FS showed a significantly higher risk compared to MS [RR 2.28, 95%CI (1.01;5.16)]. Also, patients who underwent minimally invasive approaches; MT and MS, required less need of re-exploration compared to FS [RR 0.10, 95%CI (0.02;0.45)], and [RR 0.33, 95%CI (0.14;0.79)], respectively. However, Intraoperative timings; including aortic cross-clamp, and cardiopulmonary bypass time, were significantly lower with FS than for MS [MD -9.16, 95%CI (-1.88; -16.45)], [MD -9.61, 95%CI (-18.64; -0.59)], respectively.ConclusionOur network meta-analysis shows that minimally invasive approaches offer some advantages for obese patients undergoing AVR over full sternotomy. Suggesting that these approaches might be considered more beneficial alternatives for obese patients undergoing AVR.

Mini-Aortic Valve Replacement versus Transcatheter Aortic Valve Implantation: A Propensity-Matched Study

Background. Total sternotomy for aortic valve replacement has been superseded by less invasive approaches such as mini-sternotomy or transcatheter procedures. There has been an exponential uptake in transcatheter aortic valve implantation (TAVI) in younger and lower risk patients following recent randomized trials. This study aims to compare the outcomes of patients with aortic stenosis treated with minimally invasive approaches: mini-sternotomy for aortic valve replacement (mini-AVR) and TAVI implantation. Methods. Between January 2015 and December 2021, a total of 1437 TAVI and 176 mini-AVR patients from 2 tertiary centers fulfilled the criteria and were included in the propensity matching model. Results. A total of 256 TAVIs and 146 mini-AVR were included in the matched cohort. There was no significant difference in 30-day mortality in the two groups (TAVI vs. mini-AVR 2.7% vs. 2.8%, p = 0.935 ). TAVI confers slightly lower gradients in the follow-up echo when compared with mini-AVR (peak gradient 20 ± 8.7 mmHg vs. 24.5 ± 10 mmHg, p < 0.001 ; mean gradient 10.9 ± 5.6 mmHg vs. 13.2 ± 5.7 mmHg, p < 0.001 ). On the other hand, mini-AVR exhibits remarkably lower rates of paravalvular leak (mild leak 8% vs. 41.5%, p < 0.001 ; moderate leak 2.8% vs. 0%, p < 0.001 ) and of need for permanent pacemaker implantation (2% vs. 12.2%, p < 0.001 ). Unsurprisingly, TAVI has lower in-hospital stay 3 (2 to 6) days vs. 10 (8 to 13) days, p < 0.001 ). Conclusions. For eligible aortic stenosis patients in the 7th decade of life, mini-AVR remains an excellent therapeutic option.

Ministernotomy for aortic valve replacement improves early recovery and facilitates proper wound healing - forced propensity score matching design with reference full sternotomy.

IntroductionWith the development of less invasive techniques ministernotomy has become an increasingly popular choice for minimally invasive aortic valve replacement (MIAVR). However, a large discrepancy in the published results, often derived from the center’s own experience, intensifies the need for further re-evaluation in order to better define the real impact of the ministernotomy approach on postoperative clinical condition in short- and long-term observation.AimTo assess the safety and efficacy of MIAVR in comparison to a reference full sternotomy AVR (FSAVR).Material and methodsBetween January 2004 and January 2018, 2386 patients underwent isolated surgical aortic valve replacement (AVR) at our institution. 620 patients were treated minimally invasively (MIAVR) and 1766 patients received FSAVR. Forced propensity score 1 : 1 matching and conditional regressive methods were introduced, ensuring valid comparison and correct estimation. Ultimately, 557 well allocated pairs of treated and control patients were included.ResultsIn-hospital mortality was low and comparable (1.26% for MIAVR, 1.62% for FSAVR). No significant differences in terms of serious adverse events were found, although in patients undergoing MIAVR there tended to be lower incidence of neurological complications (OR = 0.72; p = 0.09) and low output syndrome (OR = 0.66; p = 0.13). In addition to a much faster extubation and discharge from the ICU as well as improved blood management, MIAVR significantly reduced the risk of wound complications (OR = 0.31; p < 0.0010).ConclusionsMIAVR is a safe, effective and reproducible procedure providing at least as good results as FSAVR. Nevertheless, it should be especially recommended to obese, diabetic patients with pulmonary and mobility disorders in order to improve their early recovery.

Parasternal Pectoral Block for Right Anterior Minimally Invasive Thoracotomy in Cardiac Surgery

MINIMALLY invasive cardiac surgery (MICS) is being increasingly performed. 1 Gammie J.S. Zhao Y. Peterson E.D. et al. Less-invasive mitral valve operations: Trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg. 2010; 90 (1401-10.e1) Abstract Full Text Full Text PDF Scopus (270) Google Scholar Several approaches are listed under the term MICS, such as ministernotomy for aortic valve replacement, left minithoracotomy for minimally invasive direct coronary artery bypass, and right anterior minimally invasive thoracotomy (RMIT) principally for mitral or aortic valve surgery. Minimally invasive thoracotomy is associated with intense and prolonged postsurgical pain, which can be equal to that occurring after conventional sternotomy. Pain after RMIT is caused by rib retraction, pectoralis and intercostal muscle dissection, and intercostal nerve lesions. Moreover, this pain is exacerbated by breathing movements, coughing, respiratory physiotherapy, and chest tubes. 2 Furrer M. Rechsteiner R. Eigenmann V. et al. Thoracotomy and thoracoscopy: Postoperative pulmonary function, pain and chest wall complaints. Eur J Cardiothorac Surg. 1997; 12: 82-87 Crossref PubMed Scopus (150) Google Scholar

39 Ministernotomy for aortic valve replacement- is it safe and effective?

Background Surgical aortic valve replacement has been shown to be an extremely safe and effective operation. In order to reduce patient morbidity, we recently commenced a ministernotomy approach to the aortic valve. Methods Between 2012 and the present 90 aortic valve replacements have been performed using this less invasive technique. Age ranged from 33 to 87 years. The technique involved partial sternotomy of 7–8 cm with a ‘J’ to the left. Cardiopulmonary bypass was established with low profile cannulae, and the replacement of the aortic valve proceeded with a standard surgical technique in 82 patients and with a sutureless rapid deployment valve in 6 patients. Results 30 day mortality was 0%, 4 patients required conversion to full sternotomy. One patient had reoperation for bleeding post surgery. All patients were discharged well. Conclusions Aortic valve replacement via a ministernotomy is a safe and effective procedure.

Mini-sternotomy for aortic valve replacement reduces the length of stay in the cardiac intensive care unit: meta-analysis of randomised controlled trials

BackgroundMini-sternotomy for isolated aortic valve replacement aims to reduce operative trauma hastening recovery and improving the cosmetic outcome of cardiac surgery. The short-term clinical benefits from the mini-sternotomy are presumed...

Simple de-airing technique for aortic valve replacement with upper ministernotomy.

Upper ministernotomy for aortic valve replacement is intimidating for many surgeons, not only for limited surgical exposure but also for the inability to complete de-airing the apex of the heart. Conversion to full sternotomy had been reported for this inability to de-air the apex of the heart in a limited number of cases. We describe a simple de-airing method by introducing a 16 GA catheter into the apex of the left ventricle through the aorta and prosthetic valve.

“I” ministernotomy for aortic valve replacement

Background. Minimally invasive surgical approaches have been applied recently in the management of valvular heart disease. In this report, we reviewed our preliminary experience of minimally invasive aortic valve replacement.Methods. Eighteen patients were operated on by means of an “I” ministernotomy, and 16 patients were operated on by means of a full median sternotomy during the same period. There was no difference between these two groups in term of age, sex, and preoperative left ventricular ejection fraction. In patients of the ministernotomy group, the operations were approached through an “I” median sternal split, from the second to the fifth intercostal space, 8 to 10 cm in length, with transverse division. Cardiopulmonary bypass was established through aorto–right atrial cannulation with aortic cross-clamping and antegrade or retrograde delivery of blood cardioplegia.Results. Under direct vision, aortic valve replacement was performed successfully in patients of both groups. The duration of cardiopulmonary bypass time and aortic cross-clamp time was significantly longer in the ministernotomy group than in the full sternotomy group. However, the length of incision, duration of endotracheal intubation, intensive care unit stay, pain score, postoperative length of stay, and return to normal activity interval were significantly shorter and lower in patients of the ministernotomy group than in those of the full sternotomy group. All patients recovered from the operation rapidly. Follow-up was complete in all patients with no late complications. Echocardiographic examination showed good function of aortic prostheses.Conclusions. Our experience demonstrates that the “I” ministernotomy provides good exposure, reduced wound pain, enhanced recovery, shortened hospital stay, and good cosmetic healing. It may be a good alternative for surgical correction of aortic valve lesions.

Reversed “C” ministernotomy for aortic valve replacement

The technique of aortic valve replacement through a reversed “C” sternotomy incision is described. The sternal incision extends between the second and the fifth intercostal space and provides excellent exposure of the ascending aorta, the aortic root, and the right atrial appendage. The procedure can be performed with standard cannulation for cardiopulmonary bypass and conventional surgical instruments.

Ministernotomy for aortic valve replacement in a patient with osteogenesis imperfecta

Open heart operations in patients with osteogenesis imperfecta are associated with increased morbidity and mortality resulting from tissue friability and bone brittleness. We used a ministernotomy approach for aortic valve replacement in a patient with osteogenesis imperfecta, with clear benefits and a satisfactory outcome.