Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy)

Background: new minimally invasive sternotomy (mini-sternotomy) procedures have improved the treatment outcome and reduced the incidence of perioperative complications leading to improved patient satisfaction and a reduced cost of aortic valve replacement in comparison to the conventional median sternotomy (full sternotomy). The aim of this study is to compare and gain new insights into operative and early postoperative outcomes, long-term postoperative results, and 5-year survival rates after aortic valve replacement through a ministernotomy and full sternotomy. Methods: This is a retrospective study of patients who underwent an isolated replacement of the aortic valve via a full sternotomy or ministernotomy from 2011 to 2016. From 2011 to 2016, 426 cardiac interventions were performed, 70 of which (16.4%) were of the ministernotomy and 356 (83.6%) of the full sternotomy. Through propensity score matching, 70 patients who underwent the ministernotomy (ministernotomy group) were compared with 70 patients who underwent the full sternotomy (control group). Results: in the propensity matching cohort, no statistical difference in operative time was noted (p = 0.856). The ministernotomy had longer cross clamp (88.7 +/- 20.7 vs. 80.3 +/- 24.6 min, p = 0.007) and bypass (144.0 +/- 29.9 vs. 132.9 +/- 44.9 min, p = 0.049) times, less ventilation time (9.7 +/- 1.7 vs. 11.7 +/- 1.4 h, p < 0.001), shorter hospital stay (18.3 +/- 1.9 vs. 21.9 +/- 1.9 days, p = 0.012), less 24-h chest tube drainage (256.2 +/- 28.6 vs. 407.3 +/- 40.37 mL, p < 0.001), fewer corrections of coagulopathy (p < 0.001), fewer patients receiving catecholamine (5.71 vs. 30.0%, p < 0.001) and better cosmetic results (p < 0.001). Moreover, the number of patients without complaints at 1 year after the operation was significantly greater in the ministernotomy group (p = 0.002), and no significant differences in the 5-year survival between the groups were observed. In the overall cohort, the ministernotomy had longer cross clamp times (88.7 +/- 20.7 vs. 79.9 +/- 24.8 min, p < 0.001), longer operative times (263.5 +/- 62.0 vs. 246.7 +/- 74.2 min, p = 0.037) and bypass times (144.0 +/- 29.9 vs. 132.7 +/- 44.5 min, p = 0.026), lower incidence of 30-day mortality (1(1.4) vs. 13(3.7), p = 0.022), shorter hospital stays post-surgery p = 0.025, less 24-h chest tube drainage, p < 0.001, and fewer corrections of coagulopathy (p < 0.001). Conclusions: the ministernotomy has a number of advantages compared with the full sternotomy and thus could be a better approach for aortic valve replacement.