Mini-sternotomy versus conventional total sternotomy for aortic valve replacement

الملخص EN

This study compares postoperative outcomes in patients undergoing Aortic Valve Replacement (AVR) surgeries through the mini- and conventional sternotomy techniques.

Methods: This is a retrospective comparative analysis of 90 consecutive patients who underwent mini-sternotomy (mAVR) and conventional total-sternotomy (cAVR) and was divided into two separate equal groups to analyze their cardiopulmonary bypass (CPB) and aortic clamping time, surgical bleeding volume, mechanical ventilation time, atrial fibrillation incidence, ICU stay, mortality within one-month, post-operative bleeding within 24hr and bleeding required transfusion.

In this study, we excluded patients who underwent a combined procedure, reoperation surgery, and unavailable medical records.

ANOVA test has been utilized to evaluate the potentially significant differences between the two surgical techniques.

Results: There was a difference between the mAVR and cAVR patients regarding CPB duration, in the mAVR (Range = 82- 114 minutes, Mean= 98 minutes, STD deviation= 6.32 minutes), while cAVR (Range= 61-79 minutes, Mean = 69.80 minutes, STD deviation= 4.53 minutes).

The aortic cross‐clamping time in the mini sternotomy (Range = 56- 80 minutes, Mean= 67.89 minutes, STD deviation= 6.96 minutes), while conventional sternotomy (Range= 36-56 minutes, Mean = 46.64 minutes, STD deviation= 5.72 minutes).The length of intensive care unit (ICU) stay in hours was shorter for the mAVR patients (Range= 8-64, Mean = 35.87, STD deviation= 13.81 hours), against that for the cAVR patients (Range= 23-127, Mean = 55.09, STD deviation= 20.08 hours).

The mechanical ventilation (MV) duration for the mAVR (Range= 6-16 hours, Mean = 11.11 hours, STD deviation= 2.76 hours), against that for the cAVR patients (Range= 6-20 hours, Mean = 12.82 hours, STD deviation= 3.62 hours).

The postoperative bleeding within 24 hours for the mAVR patients (Range= 135-365 ml, Mean = 248.67 ml, STD deviation= 36.34 ml), against that for the cAVR patients (Range= 235-705 ml, Mean = 473.44 ml, STD deviation= 98.92 ml).

In the first 24 hours, only 10 patients of the mAVR group needed a total of 13 units of packed RBC, whereas 16 patients of cAVR required 27 units.

Mediastinal re-exploration for bleeding issues was required in one mAVR and two cAVR patients.

The atrial fibrillation for the mAVR patients and cAVR patients were 6 out of 45 patients in each surgery technique.

The mortality cases within the month were qual between each group, one case in the mAVR patients and one in the cAVR patients.

In terms of the significance of the differences between the mAVR patients and cAVR patients, concerning Cardiopulmonary bypass, aortic clamping time, mechanical ventilation time, ICU time, postoperative bleeding are significantly different with p-value (0.000, 0.000, 0.014, 0.000, 0.000) respectively, but there were insignificant differences between the mAVR patients and cAVR patients in atrial fibrillation incidence, bleeding required transfusion, a number of packed RBC, mortality case with p-value (1.000, 0.167, 0.058,1.000) respectively.

Conclusions: Mini-sternotomy is relatively less invasive, has lesser postoperative comorbidities, and reduced ICU stay as compared with conventional sternotomy.