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Comparing Mini-sternotomy Technique Via 4th Right Or 4th Left Interspace For Isolated Avr. Is Mini-l A Better Alternative To Mini-j?
Rick B. Karsan1, Tara Chan-A-Sue
2, Gwyn W. Beattie
1;
1Royal Victoria Hospital, Belfast, United Kingdom,
2Quuens University Belfast, Belfast, United Kingdom
BACKGROUND: Conventional mini-sternotomy is via the 3
rd or 4
th right intercostal space. Difficulties can arise due to access for cannulation or annulus. An alternate approach may be a ‘mini-L’ through the left intercostal space. This study aims to compare surgical and clinical outcomes between mini-J and mini-L sternotomy for isolated aortic valve replacement.
METHODS: Single-surgeon data for all mini-sternotomy aortic valve replacements from 2019 to 2023 were reviewed and grouped based on mini-J or mini-L sternotomy. Bypass, cross clamp and total surgical time were compared along with conversion to full sternotomy and post-operative AKI, stroke and total hospital time. Groups were further stratified based on rapid deployment valve vs sutured technique.
RESULTS: A total of 56 cases were analysed, 29 were via mini-J through 4
th right intercostal space and 27 via mini-L through 4
th left intercostal space. Post-operative outcomes of stroke, AKI and hospital stay were similar in both groups (P>0.05). Compared to conventional mini-J sternotomy, mini-L sternotomy showed significantly lower bypass times (112 +/- 7.52 minutes, P=0.024). Cross clamp times (89minutes) and total surgical time (217 minutes) was also seen to be reduced in the mini-L group. Conversion to full sternotomy was seen to be higher in the mini-J group compared to mini-L.
CONCLUSIONS: Mini- L sternotomy appears to improve intra-operative measures by means of better visualisation and access. This results in lower bypass, cross-clamp and total surgical time, with a lower rate of conversion to full sternotomy. This may present a better viable mini-sternotomy technique for improved access.
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