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MINIMALLY INVASIVE APPROACHES CONVERTED IN FULL STERNOTOMY:
WHAT ABOUT OUTCOMES?
Francesca Chiaramonti, Andrea Farneti, Matteo Ferrarini, Stefano Bevilacqua, Antonio Miceli, Marco Solinas, Mattia Glauber.
Heart Hospital G.Pasquinucci FTGM, Massa, Italy.

OBJECTIVE: Current evidence suggests that minimally invasive approaches (MIA) in cardiac surgery may be associated with lower postoperative mortality and morbidity compared with conventional cardiac surgery (CCS). However sometimes conversion to a full sternotomy can be required. We retrospectively reviewed patients required intraoperative conversion during MIA.
METHODS: Between January 2003 and February 2012, 1779 patients were planned for minimally invasive valve surgery. Forty-two patients (0,2%) required intraoperative conversion to a full sternotomy. Mean age was 68,7 +/- 12,7 years (range: 26 to 86 years), 22 patients were female (52%) and mean logistic EuroSCORE was 9,2 +/- 6,02%. The primary incision was a right anterior minithoracotomy in 37 patients (88%) and a ministernotomy in 5 patients (12%).
RESULTS: Overall in-hospital mortality in MIA was 1,5%, while in patients required conversion was 14% (6/42). In these patients mean logistic EuroSCORE was 17,3+/- 7,2%. Mechanical ventilation time, ICU length of stay and postoperative in-hospital stay were respectively 21,02 +/- 18,20 (range 4-72) hours, 2,3 +/- 1,73 (range 1-7) days and 8,5 +/- 5,23 (range 3-26) days. In patients who died conversion occurred due to bleeding (n=3), acute ascending aorta dissection (n=1), refractory ventricular arrhythmia (n=1) and ventricular dysfunction (n=1).
CONCLUSIONS: Minimally invasive approaches in valve surgery are safe and feasible. In our experience conversion to full sternotomy occurred rarely during MIA and lead to death rarely, especially in high-risk patients. In most cases, it was due to intraoperative adverse events like ascending aorta dissection and ventricular dysfunction that can cause death also in CCS.


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