Minimally Invasive Approach Via Right Anterior Minithoracotomy Or Mini-sternotomy For Isolated Aortic Valve Reoperation
Elisa Mikus1, Mauro Del Giglio2, Simone Calvi1, Eliana Raviola1, Alberto Tripodi1, Alberto Albertini1.
1Maria Cecilia Hospital, GVM for Care & Research, Cotignola (Ra), Italy, 2Istituto clinico San Rocco, Ome (Bs), Italy.
BACKGROUND: Aortic valve replacement after previous cardiac surgery is usually associated with an increased risk profile. The goal of this study was to compare the outcome after aortic valve replacement through minimally invasive approaches versus standard full sternotomy in redo operation. METHODS: We retrospectively reviewed 202 patients who underwent reoperative aortic valve replacement at our Institution between October 2007 and September 2017 (patients with active endocarditis were excluded). Out of 202 patients operated, 81 had minimally invasive approach via right minithoracotomy (n°=5) or upper “J” ministernotomy (n°=76) and the remaining 121 (60%) had full median sternotomy. Median age was 69.6±12 years for the minimally invasive group and 69.02±13 for the full sternotomy one (p=0.46). No statistically significant differences in terms of body mass index (p=0.70), left ventricular ejection fraction (p=0.58) and EURO score (p=0.32) have been found between the two groups. Intraoperative data and postoperative outcomes, in terms of intensive care unit stay, blood loss, transfusions and sternal wound complications have been analyzed. RESULTS: All patients received an aortic valve replacement. Mean cardiopulmonary bypass time and cross-clamp time were respectively 68.6±23.9 min and 53.6±20.9 in the minimally invasive group and 83.9±41.7 min and 61.15±26.7 in the full sternotomy group with a p<0,005 in favour of mini-invasive operations. 64% of patients in minimally invasive group and 66% in sternotomy group underwent blood transfusions, with no statistically significant differences (p=0.72). Although there is no statistically significant difference (p=0.93), post operative ventilation time resulted significantly lower in patients treated with minimally invasive technique: median was 6 versus 11 hours. Median ICU stay for patients operated through a ministernotomy or minithoracotomy and those who underwent reoperation via full sternotomy was very similar (2 vs 1,93 days - p= 0.90). In-hospital mortality in the minimally invasive group was 3,7% (3/81) compared to 4.9% reported for the traditional approach group (6/121), with no significative difference (p=0.70) CONCLUSIONS: Minimally invasive aortic valve surgery reoperation through an upper “J” sternotomy or minithoracotomy proved to be at least as safe as standard procedure in terms of hospital morbidity and mortality rates.
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