Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Minimally Invasive Approaches Versus Conventional Sternotomy for Aortic Valve Replacement: A Propensity Score Matching Study

  • Bang, Ji-Hyun (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jong-Wook (Department of Thoracic and Cardiovascular Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Lee, Jae-Won (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Joon-Bum (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Sung-Ho (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choo, Suk-Jung (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chung, Cheol-Hyun (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2011.08.12
  • Accepted : 2011.11.18
  • Published : 2012.04.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The aim of this study is to evaluate our institutional results of the aortic valve replacement through minimally invasive approaches compared with conventional sternotomy. Materials and Methods: From August 1997 to July 2010, 838 patients underwent primary isolated aortic valve replacement. Of them, 73 patients underwent surgery through minimally invasive approaches (MIAS group) whereas 765 patients underwent surgery through the conventional sternotomy (CONV group). Clinical outcomes were compared using a propensity score matching design. Results: Propensity score matching yielded 73 pairs of patients in which there were no significant differences in baseline profiles between the two groups. Patients in the MIAS group had longer aortic cross clamp than those in the CONV group ($74.9{\pm}27.9$ vs.. $66.2{\pm}27.3$, p=0.058). In the MIAS group, conversion to full sternotomy was needed in 2 patients (2.7%). There were no significant differences in the rates of low cardiac output syndrome (4 vs. 8, p=0.37), reoperation due to bleeding (7 vs. 6, p=0.77), wound infection (2 vs. 4, p=0.68), or requirements for dialysis (2 vs. 1, p=0.55) between the two groups. Postoperative pain was significantly less in the MIAS group than the conventional group (pain score, $3.79{\pm}1.67$ vs. $4.32{\pm}1.56$; p=0.04). Conclusion: Both minimally invasive approaches and conventional sternotomy had comparable early clinical outcomes in patients undergoing primary isolated aortic valve replacement. Minimally invasive approaches significantly decrease postoperative pain.

Keywords

References

  1. Konertz W, Waldenberger F, Schmutzler M, Ritter J, Liu J. Minimal access valve surgery through superior partial sternotomy: a preliminary study. J Heart Valve Dis 1996;5:638-40.
  2. Cosgrove DM 3rd, Sabik JF, Navia JL. Minimally invasive valve operations. Ann Thorac Surg 1998;65:1535-8. https://doi.org/10.1016/S0003-4975(98)00300-2
  3. Gundry SR, Shattuck OH, Razzouk AJ, del Rio MJ, Sardari FF, Bailey LL. Facile minimally invasive cardiac surgery via ministernotomy. Ann Thorac Surg 1998;65:1100-4. https://doi.org/10.1016/S0003-4975(98)00064-2
  4. Byrne JG, Mitchell ME, Adams DH, Couper GS, Aranki SF, Cohn LH. Minimally invasive direct access mitral valve surgery. Semin Thorac Cardiovasc Surg 1999;11:212-22. https://doi.org/10.1016/S1043-0679(99)70062-6
  5. Szwerc MF, Benckart DH, Wiechmann RJ, et al. Partial versus full sternotomy for aortic valve replacement. Ann Thorac Surg 1999;68:2209-13. https://doi.org/10.1016/S0003-4975(99)00863-2
  6. Colvin SB, Galloway AC, Ribakove G, et al. Port-Access mitral valve surgery: summary of results. J Card Surg 1998;13:286-9.
  7. Svensson LG, Nadolny EM, Kimmel WA. Minimal access aortic surgery including re-operations. Eur J Cardiothorac Surg 2001;19:30-3. https://doi.org/10.1016/S1010-7940(00)00597-2
  8. Byrne JG, Hsin MK, Adams DH, et al. Minimally invasive direct access heart valve surgery. J Card Surg 2000;15:21-34. https://doi.org/10.1111/j.1540-8191.2000.tb00441.x
  9. Bonchek LI, Ullyot DJ. Minimally invasive coronary bypass: a dissenting opinion. Circulation 1998;98:495-7. https://doi.org/10.1161/01.CIR.98.6.495
  10. Bonatti J, Schachner T, Bonaros N, et al. Technical challenges in totally endoscopic robotic coronary artery bypass grafting. J Thorac Cardiovasc Surg 2006;131:146-53. https://doi.org/10.1016/j.jtcvs.2005.07.064
  11. Agmon Y, Khandheria BK, Meissner I, et al. Aortic valve sclerosis and aortic atherosclerosis: different manifestations of the same disease? Insights from a population-based study. J Am Coll Cardiol 2001;38:827-34. https://doi.org/10.1016/S0735-1097(01)01422-X
  12. Cohn LH, Adams DH, Couper GS, et al. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg 1997;226:421-6. https://doi.org/10.1097/00000658-199710000-00003
  13. Grossi EA, Esposito R, Harris LJ, et al. Sternal wound infections and use of internal mammary artery grafts. J Thorac Cardiovasc Surg 1991;102:342-6.
  14. Hendrickson SC, Glower DD. A method for perfusion of the leg during cardiopulmonary bypass via femoral cannulation. Ann Thorac Surg 1998;65:1807-8. https://doi.org/10.1016/S0003-4975(98)00302-6
  15. Arom KV, Emery RW. Minimally invasive mitral operations. Ann Thorac Surg 1997;63:1219-20. https://doi.org/10.1016/S0003-4975(97)90196-X
  16. Felger JE, Chitwood WR Jr, Nifong LW, Holbert D. Evolution of mitral valve surgery: toward a totally endoscopic approach. Ann Thorac Surg 2001;72:1203-8. https://doi.org/10.1016/S0003-4975(01)02978-2
  17. Schroeyers P, Wellens F, De Geest R, et al. Minimally invasive video-assisted mitral valve repair: short and mid-term results. J Heart Valve Dis 2001;10:579-83.
  18. Lytle BW. Minimally invasive cardiac surgery. J Thorac Cardiovasc Surg 1996;111:554-5.
  19. Cosgrove DM 3rd, Sabik JF. Minimally invasive approach for aortic valve operations. Ann Thorac Surg 1996;62:596-7. https://doi.org/10.1016/0003-4975(96)00418-3
  20. Zacharias A, Habib RH. Factors predisposing to median sternotomy complications: deep vs superficial infection. Chest 1996;110:1173-8. https://doi.org/10.1378/chest.110.5.1173

Cited by

  1. Current Status of Surgical Treatment for Aortic Valve Stenosis vol.29, pp.5, 2012, https://doi.org/10.1111/jocs.12384
  2. Conventional Versus Minimally Invasive Aortic Valve Replacement: Pooled Analysis of Propensity‐Matched Data vol.30, pp.2, 2012, https://doi.org/10.1111/jocs.12493
  3. Propensity score analysis of outcomes following minimal access versus conventional aortic valve replacement vol.49, pp.2, 2012, https://doi.org/10.1093/ejcts/ezv061
  4. Minimally Invasive Aortic Valve Replacement vol.31, pp.1, 2012, https://doi.org/10.1111/jocs.12652
  5. International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally Invasive Approaches vol.11, pp.3, 2016, https://doi.org/10.1097/imi.0000000000000287
  6. Advantages of Minimal Access versus Conventional Aortic Valve Replacement in Elderly or Severely Obese Patients vol.12, pp.2, 2017, https://doi.org/10.1097/imi.0000000000000354
  7. Establishment of a minimally invasive cardiac surgery programme in Singapore vol.58, pp.10, 2017, https://doi.org/10.11622/smedj.2017022
  8. Minimal access versus conventional aortic valve replacement: a meta-analysis of propensity-matched studies† vol.25, pp.4, 2017, https://doi.org/10.1093/icvts/ivx212
  9. Improved operative and recovery times with mini-thoracotomy aortic valve replacement vol.14, pp.None, 2012, https://doi.org/10.1186/s13019-019-0912-0
  10. Minithoracotomy versus full sternotomy for isolated aortic valve replacement: Propensity matched data from two centers vol.36, pp.1, 2012, https://doi.org/10.1111/jocs.15177
  11. Comparative Evaluation of the Incidence of Postoperative Pulmonary Complications After Minimally Invasive Valve Surgery vs. Full Sternotomy: A Systematic Review and Meta-Analysis of Randomized Control vol.8, pp.None, 2012, https://doi.org/10.3389/fcvm.2021.724178
  12. Early Outcomes of Isolated Aortic Valve Replacement Through Right Anterior Minithoracotomy Using the Latest-Generation Biological Prosthesis vol.16, pp.1, 2012, https://doi.org/10.1177/1556984520975889