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Minimally invasive aortic valve replacement: comparative study of three different approaches
Lai Wei, Chunsheng Wang, Jinqiang Shen, Limin Xia, Huan Liu, Jiasi Zhu, Yiwei Xu, Wenjun Ding.
Zhongshan Hospital, Fudan University, Shanghai, China.

OBJECTIVE: Minimally invasive aortic valve replacement (AVR) has been supposed to reduce surgery trauma, decrease postoperative pain, blood loss, and shorten hospital stay. Previous study compared outcomes of partial and complete sternotomy for AVR, but there was no article compared thoracotomy to partial or complete sternotomy for AVR. This retrospective study compared outcomes of AVR with a 5-cm anterolateral thoracotomy with those of patial and complete sternotomy.
METHODS: From July 10 2009 to October 30 2012, 260 patients with aortic valve diseases underwent primary isolated AVR via complete sternotomy (N=96), partial sternotomy (n=78), or an anterolateral thoracotomy in the third intercostal space (ICS) with a groin incision for femoral connection of cardiopulmonary bypass (n=86). Outcomes of three groups were compared of in-hospital morbidity and mortality, mediastinal drainage, transfusion requirement, pain, and mid-term survival.
RESULTS: In-hospital mortality was similar in three groups: no mortality in complete sternotomy, 1.3% in the partial sternotomy group and 1.2% in the thoracotomy group (p=0.6). The thoracotomy group had longest cardiopulmonary bypass time: 25 minutes longer than complete sternotomy group and 15 minutes longer than partial sternotomy (P<0.001); myocardial ischemic time was 16 minutes longer for the thoracotomy group than complete sternotomy and 12 minutes longer than partial sternotomy(P<0.001). Neurologic, pulmonary, and renal complications were similar among three groups (P>0.1). Median hours to extubation were 4.5 hours longer for the thoracotomy group than complete sternotomy and 2.6 hours longer than partial sternotomy. The thoracotomy group had the least drainage and lowest ratio of the patient required postoperative blood transfusion contributing to shortest length of postoperative hospital stay (mean 6.3 days), 1.6 and 0.9 days shorter than for complete and partial sternotomy (p<0.01).
CONCLUSIONS: Minimally invasive aortic valve replacement through the anterolateral thoracotomy is safe and feasible as partial and complete sternotomy, with good cosmetic results and rapid postoperative recovery, and is worthy of clinical selective application.


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