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OBJECTIVE: From 2012, we started aortic valve replacement (AVR) with mini-sternotomy approach in selected patients (without no dilated component or atherosclerotic plaque at ascending aorta, barrel chest). We compared surgical outcomes and patient exercise performance estimated by cardiopulmonary exercise test (CPX) between mini-sternotomy and full sternotomy in elective isolated AVR.
METHODS: Between January 2012 and December 2014, a total of 76 patients underwent elective isolated aortic valve replacement. Twenty-eight patients were operated via mini-sternotomy (MS) and 48 via full sternotomy (FS). Surgical outcomes were compared between two approaches.
RESULTS: There was no significant difference in mean age, preoperative comorbidities, pressure gradient, EF, and NYHA classes between MS and FS patients. Euroscore II was 2.0±1.0 in MS and 2.3±13 in FS (p value 0.33). Cardiopulmonary bypass time, aortic cross-clamp time, operative time was slightly longer in MS, but not significant (118±21 vs 110±23, 86±18 vs 76±17, 235±37 vs 226±49, p value 0.68, 0.22, and 0.34 respectively). Hospital mortality was 3.6% in MS and 0% in FS. Postoperative outcomes were as follows: ventilation time 8±5hr vs 10 vs 7hr (p=0.42), prolonged ICU stay (≧4 days) 0% and 14.6% (p=0.09), wound infection (superficial or deep) 0% vs 4.2% (p=0.72), neurological complication 3.6% vs 4.2% (P=0.63). Cardio-pulmonary exercise test (CPX) was significantly better in mini-sternotomy than in full-sternotomy (Peak VO2 ml/kg/min, 12.4±1.4 vs 10.9±2.0, p<0.05) by subgroup analysis.
CONCLUSIONS: Mini-sternotomy approach can be performed safely in anatomically feasible patients. Although the rate of major operative complication was not significantly difference between two groups, mini-sternotomy was associated with better cardio-pulmonary exercise test, suggesting clinical benefit from the partial preservation of the continuity of sternum.