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Ann Thorac Surg 1999;67:1583-1587
© 1999 The Society of Thoracic Surgeons

Original Articles

Ministernotomy versus median sternotomy for aortic valve replacement: a prospective, randomized study

Alejandro Aris, MD, PhDa, Maria Luisa Cámara, MD, PhDa, José Montiel, MDa, Luis Javier Delgado, MDa, Josefina Galán, MDb, Héctor Litvan, MDb

a Departments of Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
b Department of Anesthesia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

Address reprint requests to Dr Aris, Cardiac Surgery Service, Hospital de la Santa Creu I Sant Pau, Avenida San A.M. Claret 167, 08025 Barcelona, Spain
e-mail: aaris{at}hsp.santpau.es

Presented at the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1999.

Background. Minimally invasive aortic valve replacement reduces surgical trauma and, supposedly, postoperative pain, blood loss, and length of stay. A prospective, randomized study was designed to prove these theoretical advantages.

Methods. Forty patients undergoing isolated, elective aortic valve replacement were randomized into two equal groups. Patients in group M underwent aortic valve replacement through a ministernotomy (reversed L or reversed C). In group S, a median sternotomy was used. The anesthetic and surgical protocol was identical for both groups. Pain was evaluated on a daily basis. Pulmonary function tests were performed preoperatively and before hospital discharge in all patients.

Results. There were two deaths in each group. Cross-clamp time was longer in group M: 70 ± 19 minutes versus 51 ± 13 minutes in group S (p = 0.005). There were no statistically significant differences between groups M and S in pump time (95 ± 20 minutes versus 83 ± 19 minutes), extubation time (9.9 hours in both groups), chest drainage (479 ± 274 mL/ 24 hours versus 355 ± 159 mL/ 24 hours), transfusion requirements (27% in both groups), pain evaluation (1.34 ± 1.3 versus 2.15 ± 1.5), length of stay (6.2 ± 2.3 days versus 6.3 ± 2.5 days), and cosmetic appraisal. Forced vital capacity decreased 26% from preoperative reference values in group M and 33% in group S (p = not significant). Forced expiratory volume in 1 second decreased 22% and 35%, respectively (p = not significant).

Conclusions. This study has failed to prove the theoretical advantages of minimally invasive aortic valve replacement. With this technique, cross-clamp time is longer than with a median sternotomy.




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