Ministernotomy versus median sternotomy for aortic valve replacement: a prospective, randomized study

• Published in: The Annals of thoracic surgery Vol. 67; no. 6; pp. 1583 - 1587
• Main Authors: Aris, Alejandro, Cámara, Maria Luisa, Montiel, José, Delgado, Luis Javier, Galán, Josefina, Litvan, Héctor
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-06-1999
• Subjects: Adult; Aged; Aortic Valve - surgery; Heart Valve Prosthesis Implantation - methods; Humans; Middle Aged; Minimally Invasive Surgical Procedures; Pain, Postoperative; Postoperative Complications; Prospective Studies; Respiratory Function Tests; Sternum - surgery; Treatment Outcome
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(99)00362-8

Background. Minimally invasive aortic valve replacement reduces surgical trauma and, supposedly, postoperative pain, blood loss, and length of stay. A prospective, randomized study was designed to prove these theoretical advantages.
Methods. Forty patients undergoing isolated, elective aortic valve replacement were randomized into two equal groups. Patients in group M underwent aortic valve replacement through a ministernotomy (reversed
L or reversed
C). In group S, a median sternotomy was used. The anesthetic and surgical protocol was identical for both groups. Pain was evaluated on a daily basis. Pulmonary function tests were performed preoperatively and before hospital discharge in all patients.
Results. There were two deaths in each group. Cross-clamp time was longer in group M: 70 ± 19 minutes versus 51 ± 13 minutes in group S (
p = 0.005). There were no statistically significant differences between groups M and S in pump time (95 ± 20 minutes versus 83 ± 19 minutes), extubation time (9.9 hours in both groups), chest drainage (479 ± 274 mL/ 24 hours versus 355 ± 159 mL/ 24 hours), transfusion requirements (27% in both groups), pain evaluation (1.34 ± 1.3 versus 2.15 ± 1.5), length of stay (6.2 ± 2.3 days versus 6.3 ± 2.5 days), and cosmetic appraisal. Forced vital capacity decreased 26% from preoperative reference values in group M and 33% in group S (
p = not significant). Forced expiratory volume in 1 second decreased 22% and 35%, respectively (
p = not significant).
Conclusions. This study has failed to prove the theoretical advantages of minimally invasive aortic valve replacement. With this technique, cross-clamp time is longer than with a median sternotomy.