Key result
Right mini-thoracotomy aortic valve replacement significantly reduced postoperative hospital stay (13.3 vs 21.5 days), intensive care unit stay, and blood transfusion prevalence compared to conventional sternotomy.
Why the study?
Does minimally invasive aortic valve replacement via right mini-thoracotomy or partial sternotomy improve operative and postoperative outcomes compared to conventional full sternotomy in patients undergoing isolated initial AVR?
Cohort (n=282)
No
Does minimally invasive aortic valve replacement via right mini-thoracotomy or partial sternotomy improve operative and postoperative outcomes compared to conventional full sternotomy in patients undergoing isolated initial AVR?
Absolute Event Rate: 13.3% vs 21.5%
p-value: p=0.001
Right mini-thoracotomy for aortic valve replacement provides objective benefits including shorter operative time, reduced need for blood transfusion, and faster recovery compared to conventional full sternotomy, whereas partial sternotomy does not yield significant advantages.
Right mini-thoracotomy AVR was associated with faster recovery; leaves open confirmation in RCTs and extension to partial sternotomy.
BACKGROUND: Right mini-thoracotomy and partial sternotomy are widely recognized as effective approaches in minimally invasive aortic valve replacement (AVR). The aim of this study was to evaluate the objective benefits of the respective approaches compared to the conventional approach. METHODS AND RESULTS: A retrospective analysis was performed in 282 consecutive patients who underwent isolated and initial AVR at a single cardiovascular institute between May 2007 and December 2012. Mini-thoracotomy and partial sternotomy were performed in 62 (22%) and in 26 patients (9%), respectively. Propensity score matching produced 36 (mini-thoracotomy vs. full sternotomy) and 24 (partial sternotomy vs. full sternotomy) well-matched pairs. Compared to the conventional approach, mini-thoracotomy was associated with significantly shorter operative time (235±35 min vs. 272±73 min; P=0.009), lower prevalence of blood transfusion (42%, 15/36 vs. 67%, 24/36; P=0.025), and significantly shorter intensive care unit and postoperative hospital stay (1.4±0.8 days vs. 2.2±1.1 days, P=0.001; and 13.3±6.5 days vs. 21.5±10.3 days, P=0.001; respectively). There were no significant differences in operative and postoperative data between the partial sternotomy and full sternotomy groups. CONCLUSIONS: The objective benefits of right mini-thoracotomy included early rehabilitation and lower prevalence of blood transfusion. Significant advantages of partial sternotomy were not found.
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Hiraoka et al. (2014) conducted a cohort in Aortic valve disease requiring replacement (n=282). Right mini-thoracotomy aortic valve replacement (RTAVR) vs. Conventional aortic valve replacement (CAVR) was evaluated on Postoperative hospital stay (days) (p=0.001). Right mini-thoracotomy aortic valve replacement significantly reduced postoperative hospital stay (13.3 vs 21.5 days), intensive care unit stay, and blood transfusion prevalence compared to conventional sternotomy.
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