Severin Semsroth1, Raffaela Matteucci-Gothe2, Anneliese Heinz3, Thomas Dal Capello4, Juliane Kilo3, Ludwig Müller3, Michael Grimm3, Elfriede Ruttman-Ulmer3. 1. Department of Cardiac Surgery, Center of Operative Medicine, Innsbruck Medical University, Austria. Electronic address: severin.semsroth@i-med.ac.at. 2. Department of Public Health and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria. 3. Department of Cardiac Surgery, Center of Operative Medicine, Innsbruck Medical University, Austria. 4. Tumor Registry South Tyrol, Bolzano, Italy.
Abstract
BACKGROUND: In aortic valve replacement, a comparison between the anterolateral minithoracotomy and the partial upper hemisternotomy approach has not been reported to date. METHODS: From 2006 to 2012, isolated aortic valve replacement was performed in 1,118 consecutive patients. Aortic valve replacement was performed through a anterolateral minithoracotomy in 166 patients (14.9%) and through a partial upper hemisternotomy in 245 patients (21.9%). A propensity score-matched analysis was performed in 160 matched pairs. RESULTS: Conversion to median sternotomy was significantly higher in the anterolateral group (n = 22, 13.1%) than in the hemisternotomy group (n = 7, 4.4%) (p = 0.004). A second cross-clamp was significantly more often necessary in the anterolateral group (n = 14, 8.8%) than in the hemisternotomy group (n =2, 1.3%) (p = 0.003). The median cross-clamp time was significantly longer in the anterolateral group, 93 minutes (range, 43 to 231 minutes) than in the hemisternotomy group, 75 minutes (range, 46 to 137 minutes) (p < 0.0001). The median perfusion time was significantly longer in the anterolateral group, 137 minutes (range, 81 to 456 minutes) than in the hemisternotomy group, 113 minutes (range, 66 to 257 minutes) (p < 0.0001). Significantly more groin adverse events occurred in the anterolateral group (n = 17, 10.8%) than in the hemisternotomy group (n = 0, 0%) (p < 0.0001). No significant difference in 90-day mortality was seen in the anterolateral group (n = 6, 3.8%) than in the hemisternotomy group (n = 2, 1.3%) (p = 0.16). CONCLUSIONS: The anterolateral minithoracotomy is associated with more perioperative adverse events. The partial upper hemisternotomy is an excellent surgical technique for minimally invasive aortic valve replacement in the daily routine for every staff surgeon.
BACKGROUND: In aortic valve replacement, a comparison between the anterolateral minithoracotomy and the partial upper hemisternotomy approach has not been reported to date. METHODS: From 2006 to 2012, isolated aortic valve replacement was performed in 1,118 consecutive patients. Aortic valve replacement was performed through a anterolateral minithoracotomy in 166 patients (14.9%) and through a partial upper hemisternotomy in 245 patients (21.9%). A propensity score-matched analysis was performed in 160 matched pairs. RESULTS: Conversion to median sternotomy was significantly higher in the anterolateral group (n = 22, 13.1%) than in the hemisternotomy group (n = 7, 4.4%) (p = 0.004). A second cross-clamp was significantly more often necessary in the anterolateral group (n = 14, 8.8%) than in the hemisternotomy group (n =2, 1.3%) (p = 0.003). The median cross-clamp time was significantly longer in the anterolateral group, 93 minutes (range, 43 to 231 minutes) than in the hemisternotomy group, 75 minutes (range, 46 to 137 minutes) (p < 0.0001). The median perfusion time was significantly longer in the anterolateral group, 137 minutes (range, 81 to 456 minutes) than in the hemisternotomy group, 113 minutes (range, 66 to 257 minutes) (p < 0.0001). Significantly more groin adverse events occurred in the anterolateral group (n = 17, 10.8%) than in the hemisternotomy group (n = 0, 0%) (p < 0.0001). No significant difference in 90-day mortality was seen in the anterolateral group (n = 6, 3.8%) than in the hemisternotomy group (n = 2, 1.3%) (p = 0.16). CONCLUSIONS: The anterolateral minithoracotomy is associated with more perioperative adverse events. The partial upper hemisternotomy is an excellent surgical technique for minimally invasive aortic valve replacement in the daily routine for every staff surgeon.
Authors: Martin Andreas; Paolo Berretta; Marco Solinas; Giuseppe Santarpino; Utz Kappert; Antonio Fiore; Mattia Glauber; Martin Misfeld; Carlo Savini; Elisa Mikus; Emmanuel Villa; Kevin Phan; Theodor Fischlein; Bart Meuris; Gianluca Martinelli; Kevin Teoh; Carmelo Mignosa; Malakh Shrestha; Thierry P Carrel; Tristan Yan; Guenther Laufer; Marco Di Eusanio Journal: Eur J Cardiothorac Surg Date: 2020-11-01 Impact factor: 4.191