Minimal Invasive Aortic Valve Replacement by Upper Ministernotomy Approach in Comparison to The Conventional Full Median Sternotomy Approach

Abstract

Background: Minimal invasive cardiac surgery has gained more popularity nowadays in field of cardiac surgery due to the rapid progress in equipments and techniques in this field. Ministernotomy technique for aortic valve replacement is one of the most common minimal invasive cardiac surgery techniques.

Objective: Our study aimed to evaluate the advantages and disadvantages of using minimal invasive upper ministernotmy approach versus conventional full median sternotomy approach for aortic valve replacement.

Patients and methods: The study include 60 aortic valve replacement patients done from 2017 to 2019 in Sohag University Hospitals, Egypt and Hero Heart Institute, India. 30 patients by using conventional full sternotomy approach(group A), and 30 patients by using upper ministernotomy approach with central cannulation (Group B). Operative and post-operative data were compared.

Results: Total operation time, ventilation time, ICU stay and total hospital stay, were significantly longer in conventional group (group A). Total bypass and cross clamp time were significantly longer in ministernotomy group (group B). Post-operative wound infection was significantly higher in conventional group (group A). Wound cosmoses post-operatively was better in ministernotmy group as regards patient opinion. Postoperative echocardiography showed no significant difference in post-operative pericardial effusion between both groups. Post-operative pain as well as early morbidity were significantly less in ministernotomy group (Group B). No mortality occurred in both groups.

Conclusion: Upper ministernotomy is safe approach for aortic valve replacement and show advantages over conventional full sternotomy in form of shorter operative time, shorter hospital and ICU stay, better wound cosmetics, less post-operative bleeding and less post-operative pain.