Back to Annual Meeting ePosters

OBJECTIVE:
To evaluate the technical feasibility and post-operative outcome of aortic valve replacement through ministernotomy approach.
METHODS:
retrospective study of thirty-four patients (from December 2005 to February 2009) who underwent aortic valve replacement through a ministernotomy approach (6cm midline chest incision) at a single university center.
RESULTS:
twenty-eight patients had calcified aortic valve, 3 patients had rheumatic valve disease and 3 had congenital valve disease. The mean age of patients was 65.79 yo (33-83) with female to male ratio of 1.26:1. The mean logistic Euro-SCORE was 4.72 % (1.5-12.4) with mean AV gradient of 82.73 mmHg(40-152).
The ascending aorta, the superior vena cava or the right atrial appendage were cannulated in a conventional fashion. The mean cardiopulmonary bypass time and aortic cross-clamp time were 100 (70-159) and 86.8 (66-137) minutes respectively. One patient underwent exploration for bleeding through conversion to full median sternotomy. Seven patients (20%) required transfusion of blood products. The ICU stay ranged from 1 to 7 days (mean ICU stay, 1,9 days) and the hospital stay ranged from 4 to 20 days (mean hospital stay, 8.2 days). There is no incidence of renal and neurological complications postoperatively. Seven patients (20%) developed postoperative atrial fibrilation (AF) and 1 patient required permanent pacemaker insertion. Four patients (11.7%) developed pulmonary infection post-operatively. Pre-operatively, 17 patients (50%) were in NYHA functional class III, 13 patients (38.2%) in class II and 4 patients (11.7%) in class I. At mean follow up of 52.4 months (31-69) all the patients are alive and in NYHA class I-II.
CONCLUSIONS:
our results demonstrated the safety and efficacy of the ministernotomy approach in the aortic valve replacement. The cosmetic result of the ministernotomy is acceptable and there has been no compromise in technical aspects. This method seems to have also beneficial post-operative results with regards to, blood loss, blood transfusion and post-operative complications (cardiac, neurological, pulmonary, renal, wound healing). Therefore, the ministernotomy approach can be considered as an alternative to conventional aortic valve replacement alongside with other minimally invasive approaches.