Evaluation of feasibility and outcome of isolated aortic valve replacement surgery through J-shaped upper ministernotomy: A comparative study versus full sternotomy

To evaluate intraoperative (IO) and postoperative (PO) outcome of isolated aortic valve replacement (AVR) surgery through mini-sternotomy (MSAVR) versus full-sternotomy (FSAVR). Sixty-six patients were divided into two equal groups. For MSAVR, a “J” shaped sternal incision with the transverse limb at level of the 4th intercostals space was made. In the other group, aortic valve replacement was done through full median sternotomy. IO and PO data were collected. Patients' functional status was assessed using New York Heart Association (NYHA) classification. At 6-month PO patients' satisfaction by the skin incision outcome was evaluated using a 4-point scale questionnaire. Skin wound for FSAVR was significantly longer. MSAVR consumed significantly longer total operative time, but the need for blood transfusion was significantly less. Patients of MSAVR group had significantly lower amount of 1st PO day mediastinal tube drainage, and significantly shorter durations of mechanical ventilation, ICU stay and PO hospital stay with significantly lower pain scores. Mean functional scores determined at time of discharge significantly improved in both groups, but were significantly better in MSAVR patients. Wound satisfaction score was significantly high in MSAVR patients. MSAVR is a feasible procedure despite of the narrow operative field that induced long operative times but it significantly reduced amount of postoperative drainage and improved recovery items. MSAVR is safe with minimal PO morbidities and allowed early rehabilitation and free sleep position without affection of sternal wound healing. Moreover, MSAVR provided cosmetically better wound that was strongly satisfying patients.