Early and midterm results of upper ministernotomy approach for aortic valve replacement

Background

Aortic valve replacement (AVR) surgery today offers excellent results with low morbidity and mortality. However, the evolution of surgery encourages us to develop minimally invasive techniques. We report in this study our early experience of AVR by Upper Ministernotomy and describe the surgical technique, learning curve, complications and surgical follow-up.

Methods

Between March 2009 and March 2013, 50 patients underwent surgery for AVR at Zagazig university hospitals by inverted T Upper Ministernotomy (mean age 48 ± 11.2). The mean Euro-SCORE was 5.7% ± 4.1 and the ejection fraction was 60% ± 12. Six patients had an associated ascending aortic replacement. The cannulation was performed in femoro-femoral by the direct or percutaneous approach.

Results

Mean aortic clamping time for patients with isolated AVR was 91 ± 29 min and bypass time of 123 ± 56 min. One patient required conversion to sternotomy. The mean duration of mechanical ventilation was 10.3 ± 26.3 h, the average length of stay in intensive care units was 2.6 ± 2.2 days, and the mean hospital stay was 9.3 ± 5.8 days. Hospital mortality was 2 patients (4%).

Conclusions

The Upper mini-sternotomy for aortic valve surgery is an approach that offers many benefits. However, it is technically more complicated and requires a learning curve beyond which it can offer a lower complication rate with lower pain, blood loss and transfusion, and rapid return to normal activities.