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Ihsan Bakir
Filip P. Casselman
Francis Wellens
Hugues Jeanmart
Raphael De Geest
Ivan Degrieck
Frank Van Praet
Hugo Vanermen
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Right arrow Valve disease

Ann Thorac Surg 2006;81:1599-1604
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Minimally Invasive Versus Standard Approach Aortic Valve Replacement: A Study in 506 Patients

Ihsan Bakir, MD a , b , Filip P. Casselman, MD, PhD a , b , * , Francis Wellens, MD a , b , Hugues Jeanmart, MD a , b , Raphael De Geest, MD a , b , Ivan Degrieck, MD a , b , Frank Van Praet, MD a , b , Yvette Vermeulen, MS a , b , Hugo Vanermen, MD a , b

a Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
b Cardiovascular and Thoracic Surgery Department, OLV Clinic, Aalst, Belgium

Accepted for publication December 2, 2005.

* Address correspondence to Dr Casselman, Cardiovascular and Thoracic Surgery Department, OLV Clinic, Moorselbaan 164, Aalst 9300, Belgium (Email: filip.casselman{at}olvz-aalst.be).

BACKGROUND: Minimally invasive aortic valve replacement through partial upper sternotomy has been shown to reduce surgical trauma, and, supposedly, decrease postoperative pain, blood loss, and hospital stay.

METHODS: From October 1997 until November 2004, 506 patients received isolated aortic valve replacement, of which 232 underwent the minimal access J-sternotomy approach (group 1). The control group (group 2) consisted of 274 patients who underwent aortic valve replacements by median sternotomy. We retrospectively reviewed outcomes of the patients in the early follow-up period.

RESULTS: In group 1 and group 2, respectively, early mortality was 2.6% (6 patients) and 4.4% (12 patients). The minimal access group had reduced aortic cross-clamp and cardiopulmonary bypass times compared with conventional group: 61.8 ± 16.6 versus 69.5 ± 16.6 minutes (p < 0.05) and 88.8 ± 23.2 versus 100.2 ± 22.6 minutes (p < 0.05), respectively. Mean blood loss was lower in group 1 compared with group 2 (p < 0.05). Intensive care unit and hospital stays were shorter in the minimal access group: 2.1 ± 2.5 versus 2.5 ± 5.3 days (p = nonsignificant) and 10.8 ± 7.1 versus 12.8 ± 10.6 days (p < 0.05), respectively.

CONCLUSIONS: Aortic valve replacement can be performed safely through a partial upper sternotomy on a routine basis for isolated aortic valve disease.




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