Partial versus Full Sternotomy for Aortic Valve Replacement

Islam  Moheb Ibrahim; Ahmed  Labib Dokhan; Mohammed Fawzy Eltaweel; Hesham  Hassan Ahmed; Montaser Elsawy Abd Elaziz

doi:10.35810/ects.v2i4.164

Islam Moheb Ibrahim Department of Cardiothoracic Surgery, Menoufia University, Menoufia, Egypt
Ahmed Labib Dokhan Department of Cardiothoracic Surgery, Menoufia University, Menoufia, Egypt
Mohammed Fawzy Eltaweel Department of Cardiothoracic Surgery, Menoufia University, Menoufia, Egypt
Hesham Hassan Ahmed Department of Cardiothoracic Surgery, Menoufia University, Menoufia, Egypt
Montaser Elsawy Abd Elaziz Department of Cardiothoracic Surgery, Menoufia University, Menoufia, Egypt

DOI: https://doi.org/10.35810/ects.v2i4.164

Keywords: Aortic valve replacement, Full sternotomy, Mini-sternotomy

Abstract

Background: Minimal invasive approaches are used more frequently for aortic valve replacement (AVR). This study aimed to compare the outcomes of both minimally invasive upper mini-sternotomy and full sternotomy for AVR.

Methods: 100 patients with isolated aortic valve disease were enrolled in this prospective observational study. We grouped the patients according to the technique, group A (n=40) underwent upper J-shaped mini-sternotomy, and group B (n=60) underwent full sternotomy. Study endpoints were operative times and pain score.

Results: The mean age of the patients was 46.4±10.1 years. There was no difference in preoperative data between both groups. There was a significant difference in aortic cross-clamp time (87.2± 8.6 vs. 59.2± 6.6 min in group A and B, respectively, p= 0.001), and total bypass time (115.1± 9.2 vs. 75.3± 4.3 min in group A and B, respectively, p= 0.001) between both groups. The total operative time was 341±11.7 and 196.1±18.4 min in groups A and B, respectively (p= 0.001). The ICU stay was 29.4±8.2 hours in group A and 41.2±13.3 hours in group B (p= 0.001). Patients who had mini-sternotomy had lower pain (p= 0.001) and better patient satisfaction score (p< 0.001).

Conclusion: J-shaped upper mini-sternotomy is a safe and effective strategy for aortic valve replacement. The procedure may be associated with decreased pain and comparable morbidity to the conventional approach.