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Less Invasive Aortic Valve Replacement: Partial Upper Sternotomy vs. Right Anterior Mini Thoracotomy
Lisardo Garcia1, Niberto L. Moreno, MD2, Michael Glamore, MD3.
1Baptist Health of South Florida/Florida International University, Miami, FL, USA, 2Baptist Health of South Florida, Miami, FL, USA, 3Florida International University, Miami, FL, USA.
OBJECTIVE: To compare two different less invasive approaches, partial upper sternotomy (PUS) and right anterior mini thoracotomy for aortic valve replacement performed by the same group of surgeons.
METHODS: Retrospective study of patients operated in a two year period at the same institution by the same group of surgeons. Deidentified preoperative, intraoperative and post-operative data were pulled from our database and compared. Basic descriptive statistics including means, standard deviations and 95% confidence intervals were computed using Microsoft Excel.
RESULTS: There were no major differences in comorbidities or left ventricular ejection fraction among the 3 groups. STS scores were significantly higher in the CNV group. The total length of surgery and aortic cross clamp time were significantly longer in RAMT. Hospitalization was shorter in RAMT; PUS and RAMT required less total packed red blood cells. There were no significant differences in complications or in hospital mortality.
CONCLUSIONS: Aortic valve replacement via RAMT or PUS result in less blood transfusions and lower ventilation times and RAMT was associated with reduced hospital stay. Although RAMT had longer CPB and operative time these did not have a short term negative impact. Differences in operative times, blood loss, ventilation times and length of stay should be taken into account when a surgeon choses a particular technique.
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