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Revista chilena de cardiología

On-line version ISSN 0718-8560

Abstract

BAHAMONDES, Juan Carlos. Ministernotomy for aortic valve surgery: a 15-year experience. Rev Chil Cardiol [online]. 2021, vol.40, n.1, pp.20-26. ISSN 0718-8560.  http://dx.doi.org/10.4067/S0718-85602021000100020.

Background:

Aortic valve surgery can be performed through a reduced ministernotomy with less surgical trauma, improved cosmetics, faster recovery and excellent long-term results.

Aim:

To report the long-term results obtained with the minimally invasive approach technique in Southern Chile.

Methods:

A retrospective cohort study of 286 patients operated with the less invasive technique compared to 1161 patients operated on with full sternotomy for aortic valve replacement between 2004 and 2019 was performed. Arterial and venous cannulation was performed using small cannulas. Mean extracorporeal circulation flow was 4.5 L/min. Antegrade and retrograde cold cardioplegia was used. Statistical Analysis: Data are reported with measures of central tendency and dispersion. Categorical variables were compared with the X^2 test and ANOVA. Actuarial survival rate was calculated by Kaplan Meier method. The Stata 14 package was used for data analysis.

Results:

Demographic characteristics are shown in Table 1. Mean age of the whole cohort was 62.1 y/o (SD 6.4). There was no difference in 30 day mortality between groups. Incidence of arrhythmia, cerebral complications and AV block requiring pacemaker was similar between groups. There were no significant statistical differences in reoperation for bleeding, days of stay at the ICU and overall hospital stay. Mean follow up was 101 ± 4 (1169) months. After surgery most patients are in FC I and free from cardiac events and reoperation. In the postoperative period echocardiographic assessment was performed in 86% of patients showing similar hemodynamic function of the implanted valve. Actuarial survival rate was 97% and probability of freedom from cardiac events was 93% at 156 months of follow up.

Conclusions:

Ministernotomy is an excellent approach for aortic valve surgery which can be performed with very good results not inferior to those obtained with full sternotomy thus simplifying the surgical technique and reducing local hospital costs.

Keywords : mini-sternotomy; aortic valve, surgery; minimally invasive surgery.

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