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OBJECTIVE: Mini-sternotomy as access to the heart represents an increasingly used technique, particularly for aortic valve surgery. We report our experience with these approaches for aortic valve replacement (AVR) and more complex procedures. We particularly focus on patients with severely reduced ejection fraction (EF).
METHODS: 323 patients underwent cardiac surgery via partial sternotomy (“upper J” or “reversed Z”-sternotomy) between 8/2009 and 05/2013. Mean age was 73 ± 10 years. AVR was performed in 275 patients, in 35 patients in combination with surgery on the ascending aorta (AA). Isolated AA-procedures were found in 13 patients. 31 patients (9.6 %) showed an EF < 0.25 (group EF), compared to 292 control patients with an EF ≥ 0.25.
Follow-up was performed 1 year postoperatively.
RESULTS: ICU- and hospital stay were comparable between controls and group EF (26±8 vs. 31±14 hours; 12.1±4.0 vs. 14.2±6.5 days, p>0.05) after ministernotomy. There was no significant difference with regard to in-hospital mortality with 2.1 % in controls and 3.2 % in patients with poor EF (p>0.05). Duration of operation, of extracorporeal circulation, and of aortic cross-clamping was tendentially prolonged in group EF (p=0.05). In this group, perioperative LCOS could be detected in 3 patients (9.7 %) compared to 4.5 % in control patients.
Altogether, 7 patients needed a conversion to full sternotomy (2.2 %), in 8 patients a re-operation due to bleeding was necessary (2.5 %), each without differences between the 2 groups.
The most common postoperative complications in all patients were new-onset atrial fibrillation (15.2 %), neurological complications (2.2 %), and sternal wound infections (2.5 %). At follow-up, survival was 95.2 % in controls and 80.1 % in patients with impaired EF (p<0.05).
CONCLUSIONS: We could prove the feasibility of ministernotomy for aortic valve surgery and further procedures on the AA, likewise for patients with severely reduced cardiac function. The poorer survival rate in these patients 1 year after surgery corresponds to contemporary results achieved with conventional sternotomy.