Repeated Minimally Invasive Approach Versus Full Sternotomy In Redo Heart Surgery Patients
Bleri Çelmeta1, Marina Cannoletta2, Antonio Miceli1, Matteo Ferrarini1, Mattia Glauber1.
1Istituto Clinico Sant'Ambrogio, Milan, Italy, 2Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
BACKGROUND: The experience of minimally invasive cardiac surgery (MICS) in many centers around the world is always growing. Surgeons are therefore facing always more patients needing a redo heart surgery which were previously treated by means of a MICS. This study aims to respond the question whether differences in terms of postoperative morbidity and mortality exist between sternotomy versus repeated minimally invasive approach in this group of patients.
METHODS: The inclusion criteria were: previous MICS and need for a redo heart surgery. The period of study included the time between November 2014 and March 2021. A total of 30 patients were divided in two groups: 5 patients in the conventional group (full sternotomy) and 25 in the mini-invasive group (mini-sternotomy, right mini-thoracotomy). Intra-operative and post-operative characteristics between the groups were confronted.
RESULTS: 40% of the patients were males, the mean age was 62.4+/-8.6 years while mean EuroSCORE II was 5.4+/-4.5. All preoperative characteristics and comorbidities were similar between the groups. In the MICS group, right mini-thoracotomy constituted 92% of all patients, while mini-sternotomy the remaining 8 %. 100% of patients in the sternotomy group and 96% of MICS group were valvular surgeries. 4% of the MICS group were surgeries on ascending aorta. Mean CPB and cross-clamp times were 162.4 +/- 47.1 minutes and 92.8 +/- 31.1 minutes respecively and they were similar between the two groups. No intrahospital mortality was registered. No significant differences were found between the two groups in terms of postoperative complications, particularly referring to the rates of pulmonary impairment, postoperative pneumothorax, postoperative stroke and acute kidney injury. The ICU and hospital stay were 2.2 +/- 1.2 days and 9.1 +/- 3.6 days respectively without differences between the groups. Only one patient belonging to the sternotomy group underwent a reopening for bleeding. The need for red blood cells, plasma and platelets unit transfusion was also similar between the groups.
CONCLUSIONS: Repeated mini-invasive approach in redo heart surgery patients is feasible, safe and is associated to similar postoperative results when compared to the full sternotomy approach.
| All patients (n=30) | Minimallyinvasive approach (n=25) | Standard approach (n=5) | p | |
| EuroSCORE II | 5.4 +/- 4.5 | 5.2 +/- 4.7 | 6.6 +/- 3.8 | 0.5 |
| Intrahospital mortality | 0 | 0 | 0 | NA |
| Intensive care Unit stay (days) | 2.2 +/- 1.2 | 2.2 +/- 1.3 | 2.6 +/- 1.2 | 0.5 |
| Hospital stay (days) | 9.1 +/- 3.6 | 9.1 +/- 3.9 | 9.2 +/- 1.3 | 0.9 |
| Need for transfusion | 8 (26.7) | 7 (28) | 1 (20) | 1 |
| Reopening for bleeding | 1 (3.3) | 1 (4) | 0 | 1 |
| Stroke | 0 | 0 | 0 | NA |
| Pulmonary impairment | 1 (3.3) | 1 (4) | 0 | 1 |
| Pneumothorax | 0 | 0 | 0 | NA |
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