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The Efficacy And Outcome Of Ministernotomy Compared To Standard Sternotomy For Double Valve Replacement
Asraful Hoque, ABU SHADAT MOHAMMAD SAEM KHAN;
National Institution Of Cardiovascular Diseases, Dhaka, Bangladesh, DHAKA, Bangladesh
BACKGROUND: In this study, we compared the outcomes of combined aortic and mitral valve surgery through minimally invasive upper partial sternotomy versus conventional median sternotomy.
METHODS: This study was conducted at the National Institute of Cardiovascular Diseases, Bangladesh from January 2019 to January 2021. Total thirty patients were prospectively enrolled in our study and assigned into two equal groups. All patients above 18 years old of both genders with indications for replacement of both aortic and mitral valve were enrolled in this study. Total fifteen patients were assigned to group -A which were in minimally invasive upper mini-sternotomy. The other fifteen (15) patients were assigned to group -B which were in conventional full median sternotomy.
RESULTS: The age of group A was 34.20±6.16 years and of the full median sternotomy group B was 35.27 ±5.31 with no statistical difference between two groups (P=0.6144 ). The mean cross-clamp time, CPB time and total operative time were slightly longer in the group A than in group B but showed no statistically significant differences (p-values are 0.1129, 0.0947 and 0.0773, respectively). Postoperative bleeding or the amount of chest tube drainage in the first 24 hours was significantly less in group A (433.33±58.64 ml) when compared with group B (497.33 ±69.95 ml) with p-values of 0.0112. The mean duration of mechanical ventilation was significantly shorter in group A (5.90±0.88 hours) than in group B (6.53± 0.746 hours) with p-value of 0.0428. The length of ICU stay was significantly less in group A (3.93±0.46 days) than group B (4.47±0.64 days) with statistical difference (P=0.0130). There was less pain in MICS DVR group. The average length of hospital stay was also less in group A which was 6.47 ±0.64 days for the group A and 7.07±0.59 days for group B with statistical difference (P=0.0125 ). No difference was found between the two groups as regards the mortality.
CONCLUSIONS: Combined aortic and mitral valve surgery through upper partial sternotomy with approaching the mitral valve through the dome of the left atrium is safe and effective with the advantages of less postoperative blood loss, need for blood transfusion and mechanical ventilation time compared with conventional aortic and mitral valve surgery.
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