Right Minithoracotomy Versus Upper Mini-Sternotomy in Minimally Invasive Aortic Valve Replacement Surgeries

Abstract Background: Minimally invasive aortic valve surgery has evolved into a well-tolerated, efficient surgical treatment option in experienced centers, providing greater patient satis-faction and lower complication rates. Potential advantages of minimally invasive aortic valve replacement (MIAVR) arise from the concept that patient morbidity and potential mortality could be reduced without compromising the excellent results of the conventional procedure which include improved cosmetic results, safer access in the case of re-operation, less post-oper-ative bleeding, fewer blood transfusions, lower intensive care unit and in-hospital stays. Aim of Study: To compare intraoperative and immediate postoperative outcomes of mini-sternotomy versus mini-thor-acotomy as less invasive techniques in patients with isolated aortic valve disease requiring surgery according to inclusion criteria. Patients and Methods: Fifty patients with aortic valve dis-ease randomized into two equal groups; group "A" underwent aortic valve surgery through a minimally invasivemini-sternot-omy. Group "B" underwent aortic valve surgery through right anterior thoracotomy. The Pain was evaluated on first, second and fifth day post-operatively. Echo-cardiographic data were performed pre-operatively and at the 3rd month after discharge in all patients. Aortic and double stage venous canulationwith antegrade blood cardioplegia was adopted in group"A", while in group "B" aorto-femoral and fem-fem arterial and venous cannulation was adopted with antegrade blood cardioplegia. Results: There was no statistical difference between the two groups pre-operatively regarding their age, sex, NYHA class, echo data and spirometric study. There was one case of mortality in mini-sternotomy group Few post-operative compli-cations occurred in both groups. Total hospital stay, ICU stay, post-operative bleeding, inotropic requirement, ventilatory sup-port, blood transfusion was less in group "B" mini-thoracotomy group, with better cosmetic appearance, more cost effective.
Conclusion: Right mini-thoracotomy minimally invasive technique for aortic valve replacement provides excellent ex-posure of the aortic valve and offers a better cosmetic scar. In addition, minimally invasive right mini-thoracotomy is as safe as mini-sternotomy for aortic valve surgery, with fewer com-plications and post-operative pain, less ICU and hospital stay, fast recovery to work with limited movement restriction after surgery. However using mini-sternotomy approach decrease cardiopulmonary bypass (CBP) time.