Heart 1998;79:605-607 ( June )
Minimally invasive aortic valve replacement through a transverse sternotomy: a word of caution
a Department of Cardiothoracic Surgery, Wythenshawe
Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK, b Department of
Cardiology, Wythenshawe Hospital
Correspondence to: Mr Hooper
Accepted for publication 26 January 1998
Objectives
To compare aortic valve replacement
(AVR) using a minimally invasive approach through a transverse
sternotomy with the established approach of median sternotomy.
DesignRetrospective, case-control study.
PatientsFourteen high risk patients (median age
78, Parsonnet score of 18%) who underwent AVR performed through a
minimally invasive transverse sternotomy were compared with a
historical group of patients matched for age, sex, and Parsonnet score
who underwent AVR performed through a median sternotomy by the same surgeon.
Outcome measuresCross clamp time, total bypass
time, intensive care stay, postoperative in-hospital stay, morbidity,
and mortality.
ResultsThere were two deaths in the minimally
invasive group and none in the control group (NS). The cross clamp and
total bypass times were longer in the minimally invasive group (67 and
92 minutes v 46 and 66 minutes, p < 0.001). There was a
higher incidence of re-exploration for bleeding (14% v
0%) and paravalvar leaks (21% v 0%) in the minimally
invasive group but these differences were not significant. The
minimally invasive group had a longer postoperative in-hospital stay
(p = 0.025). The incidence of mortality or major morbidity was 43%
(six of 14) in the minimally invasive group and 7% (one of 14) in the
matched pairs (p = 0.013).
ConclusionsAVR can be performed through a
transverse sternotomy but the operation takes longer and there is an
unacceptably high incidence of morbidity and mortality.
© 1998 by Heart
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