Table of Contents
ISRN Minimally Invasive Surgery
Volume 2014, Article ID 254084, 6 pages
http://dx.doi.org/10.1155/2014/254084
Clinical Study

The Efficacy and Outcome of Ministernotomy Compared to Those of Standard Sternotomy for Aortic Valve Replacement

1Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, MAP 5, New York, NY 10467, USA
2University of Bonn, College of Medicine, Bonn, Germany

Received 18 September 2013; Accepted 3 November 2013; Published 19 February 2014

Academic Editors: N. Al-Attar and A. S. Al-Mulhim

Copyright © 2014 Edvard Skripochnik et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Benefits of ministernotomy have been reported but not yet fully established in the current literature. Ministernotomy may be associated with less bleeding, less need for transfusion, and reduced hospital length of stay. Methods. We retrospectively evaluated 347 patients who underwent aortic valve replacement between 2007 and 2011 at our institution. Results. Standard sternotomy was performed in 303 patients (154 males, 50.8% and 149 females, 49.2%) and ministernotomy in 44 patients (13 males, 30% and 30 females, 70%); most of the patients in ministernotomy group were female (75%) . The mean age for ministernotomy patients was years and for sternotomy patients years . Significant preoperative morbidities (for ministernotomy and sternotomy, resp.) included stroke (11%, versus 18%, ; ), PVD (23%, versus 16%, ; ), COPD (25%, versus 17%, ; ), renal failure (0.0%, versus 8.8%, ; ), and previous heart surgery (9%, versus 9.5%, ; ). Intraoperative blood transfusion was required in 23% of ministernotomy patients and 30% of sternotomy patients , . Major postoperative complications (for ministernotomy and sternotomy, resp.) included exploration for bleeding (4.5%, versus 6%, ; ) and adverse neurologic events (4.5%, versus 1.6%, ; ). The length of stay (LOS) in the CCU was hours for the ministernotomy group and hours for the sternotomy group . The LOS was slightly shorter following ministernotomy ( days) compared to sternotomy ( days) . Perioperative mortality was 2.3% for ministernotomy and 3.3% for sternotomy . The 1-, 3-, and 7-year survival following ministernotomy was 93.8%, 93.8%, and 88.3%, respectively; following sternotomy, these rates were 87.7%, 83.7%, and 82.6%, respectively (95% CI 0.273 to 1.325, ). Conclusion. Ministernotomy is less invasive and is associated with less perioperative and postoperative bleeding and reduced LOS in CCU and in hospital.