Comparison between mini-access and median sternotomy for aortic valve replacement: propensity score matching analysis

Objective. To compare the immediate and long-term results of sternotomy and mini-approach for aortic valve replacement. Material and methods. A retrospective study included 718 patients who underwent isolated aortic valve replacement between April 2009 and December 2019. Propensity score matching was performed due to significant differences in clinical and demographic parameters. Two groups were distinguished: group I (sternotomy) — 67 patients, group II (mini-access) — 67 patients. Inclusion criteria: isolated aortic valve replacement, age ≥18 years. Exclusion criteria: Ross procedure, AVNeo, combined interventions, left ventricular ejection fraction≤40%, repeated interventions. The median follow-up period was 44 (7—80) months. Results. Duration of surgery, cardiopulmonary bypass and myocardial ischemia was similar in both groups (155 versus 165 min, p=0.4; 87 versus 92 min, p=0.4; 68 versus 70 min, p=0.4). There was no in-hospital mortality, stroke or perioperative myocardial injury. No significant difference was found in postoperative complications and length of ICU- and hospital-stay. Incidence of explorations for bleeding (3% vs 1.5%, p=0.9), pacemaker implantation (3% vs 1.5%, p=0.9), acute kidney injury (1.5% vs 0%, p=0.9) and sternal infection (0% vs 1.5%, p=0.9) was similar. One, 3-, 5- and 9-year survival was 100%, 100%, 94.7% and 81.5% after sternotomy, 100%, 91.1%, 85.9% and 85.9% after mini-access (p=0.34). Nine-year freedom from redo surgeries was 92% and 97%, respectively (p=0.84). Conclusion. There was no significant difference in immediate and long-term results.