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Chirurgia 2019 February;32(1):8-12

DOI: 10.23736/S0394-9508.18.04827-1


language: English

Suitability of partial sternotomy for aortic valve and major aortic surgery

Miklós BITAY 1 , Filiberto SERRAINO 2, Antal SZABÓ-BICZÓK 1, Raman SHERGILL 2, Jatzek SOSZTEK 2

1 Department of Cardiac Surgery, University of Szeged, Szeged, Hungary; 2 Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK

BACKGROUND: The advantages of minimally invasive access regarding postoperative short- and long-term recovery have been presented in many previous publications. In this retrospective propensity matched study, we aim to report our results on aortic valve and major aortic surgery performed through partial sternotomy, compared with a matched group of patients operated through full sternotomy.
METHODS: Between 2013 and 2016, 163 consecutive patients (group A) operated through partial sternotomy were compared with 315 propensity matched patients operated through full sternotomy (B). The patients’ mean age was 68 and 67 years, respectively. The mean ejection fraction was above 50% in both groups and the incidence of comorbidities was also similar. In group A, 79% of the procedures were aortic valve replacements (AVR) (16% sutureless) and 21% were major aortic interventions (modified Bentall 5%, AVR and ascending aorta replacement 1.2%, valve sparing root replacement 4%, aortic valve repair, homograft implantation 3%), and AVR combined with left and right sided radiofrequency ablation (5%). The partial sternotomy was either “J” (25%), or “V” (75%) shaped, to the 3rd intercostal space, with a 3-inch skin incision. In group B, 79% were AVR operations, 21% were major aortic and AVR combined with left and right sided radiofrequency ablation.
RESULTS: The follow-up was between 1 and 3 years. Thirty-day mortality in group A was lower than in group B (0.6% vs. 2.9%, P=0.19), as well as the incidence of postoperative neurological complications (1.2% vs. 3.2%, P=0.32) and the incidence of postoperative dialysis (1.8% vs. 3.8%, P=0.37), the differences were not statistically significant. There were significant differences between cardiopulmonary bypass time (A: 94.24 min vs. B: 105.82 min, P=0.013) and cross-clamping time (A: 61.53 min vs. B: 76.08 min, P=0.0001)
CONCLUSIONS: The partial sternotomy approach, be it “J”- or “V”-shaped, offers the possibility of safely performing all types of interventions involving the aortic valve, root, and ascending aorta.

KEY WORDS: Minimally invasive surgical procedures - Sternotomy - Aorta - Vascular surgical procedures - Transcatheter aortic valve replacement

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