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Minimally invasive aortic valve replacement via minithoracotomy versus minsternotomy in a series of 1130 patients. A multicenter study.
KHALIL FATTOUCH, MD1, PIETRO DIOGUARDI, MD1, MAURO DEL GIGLIO, MD2, ALBERTO ALBERTINI, MD3, RENATO GREGORINI, MD4, ROBERTO COPPOLA, MD5, GIUSEPPE NASSO, MD6, GIUSEPPE SPEZIALE, MD6.
1GVM Care and Research - Maria Eleonora Hospital, Palermo, Italy, 2GVM Care and Research - Maria Cecilia Hospital, Cotignola, Italy, 3GVM Care and Research - Maria Cecilia Hospital, cotignola, Italy, 4GVM Care and Research - Citta' di Lecce Hospital, Lecce, Italy, 5GVM Care and Research - ICLAS - Istituto Clinico Ligure di Alta SpecialitÓ, RAPALLO, Italy, 6GVM Care and Research - Anthea Hospital, Bari, Italy.

OBJECTIVE: Most aortic valve replacements (AVR) are generally performed through a conventional full median sternotomy. There have been many attempts, however, to make the procedure less invasive by reducing incision size and keeping a portion of the sternum intact. Techniques include partial upper and lower sternotomies, small anterolateral thoracotomies, parasternal incisions, and transverse sternotomies. The most common minimally invasive approach is a partial upper sternotomy (ministernotomy). Few centers are currently using either ministernotomy and minithoracotomy. The superiority of one of both techniques is still unclear. The aim of the present study was to compare minimally invasive AVR by way of a right anterior minithoracotomy with ministernotomy on early outcomes and survival.
METHODS: Nine centers of GVM Care and Research were involved. Patients data were collected and prospectively entered in the electronic database to document surgical indications, in-hospital morbidity and mortality, need for blood products use, total length of ICU and hospital stays, and postoperative echocardiographic evaluation. After obtaining the institutional review board approval, patient’s data were analyzed using a logistic regression to evaluate the impact of surgical access on postoperative outcomes. A total of 1130 patients underwent AVR (854 ministernotomy and 276 full minithoracotomy) since Jannuary 2010.
RESULTS: The baseline characteristics were similar in both groups. There was no difference in mortality (odds ratio 0.51, 95% confidence interval 0.14- 1.74), cross-clamp and bypass times (76.8 vs 78.7 minutes and 62.4 vs 62.6 minutes, p-value=ns), hospital stays (11.4 vs 11.5 days), incidence of postoperative atrial fibrillation (223 [28.8%] vs 85 [32.2%]; P = ns) and blood transfusions 324 [41.2%] vs 106 [40.6%]; P = ns). In addition, the occurrence of stroke, renal failure, reexploration for bleeding, wound infection, mean size of prosthesis and paravalvular leak were similar in both groups.
CONCLUSIONS: Minimally invasive aortic valve replacement is feasible and safe. It’s still not demostrated difference in terms of results between minsternotomy and minithoracotomy. The minithoracotomy approach is still challange for surgeon and need high skill.


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