Original Articles
“I” ministernotomy for aortic valve replacement

https://doi.org/10.1016/S0003-4975(99)00314-8Get rights and content

Abstract

Background. Minimally invasive surgical approaches have been applied recently in the management of valvular heart disease. In this report, we reviewed our preliminary experience of minimally invasive aortic valve replacement.

Methods. Eighteen patients were operated on by means of an “I” ministernotomy, and 16 patients were operated on by means of a full median sternotomy during the same period. There was no difference between these two groups in term of age, sex, and preoperative left ventricular ejection fraction. In patients of the ministernotomy group, the operations were approached through an “I” median sternal split, from the second to the fifth intercostal space, 8 to 10 cm in length, with transverse division. Cardiopulmonary bypass was established through aorto–right atrial cannulation with aortic cross-clamping and antegrade or retrograde delivery of blood cardioplegia.

Results. Under direct vision, aortic valve replacement was performed successfully in patients of both groups. The duration of cardiopulmonary bypass time and aortic cross-clamp time was significantly longer in the ministernotomy group than in the full sternotomy group. However, the length of incision, duration of endotracheal intubation, intensive care unit stay, pain score, postoperative length of stay, and return to normal activity interval were significantly shorter and lower in patients of the ministernotomy group than in those of the full sternotomy group. All patients recovered from the operation rapidly. Follow-up was complete in all patients with no late complications. Echocardiographic examination showed good function of aortic prostheses.

Conclusions. Our experience demonstrates that the “I” ministernotomy provides good exposure, reduced wound pain, enhanced recovery, shortened hospital stay, and good cosmetic healing. It may be a good alternative for surgical correction of aortic valve lesions.

Section snippets

Material and methods

Eighteen randomly selected patients, 11 men and 7 women, 25 to 73 years old (mean, 55.1 years), were operated on for isolated aortic stenosis (10 patients) or aortic regurgitation (8 patients) through an “I” ministernotomy at Chang Gung Memorial Hospital, Taipei, Taiwan (MINI group). Patients associated with coronary artery disease, mitral or tricuspid valvular disease, severe aortoiliac occlusive disease, or severe atherosclerotic disease of the ascending aorta were excluded from this

Results

Aortic valve replacements were performed in all patients. Conversion to full sternotomy did not occur in any patient of the MINI group. The length of skin incision was significantly shorter in patients of the MINI group (Table 2). The aortic cross-clamping time was 40 to 78 minutes (65 ± 8 minutes, mean ± standard deviation) in patients of the MINI group and was 30 to 52 minutes (40 ± 5 minutes) in those of the FS group (p < 0.05) (Table 2). The total bypass time was 55 to 90 minutes (77 ± 7

Comment

In this report, 18 patients were operated on successfully by “I” ministernotomy for aortic valve lesion. Compared with 16 patients operated on through full sternotomy, the incision length was shortened, the incisional pain was reduced, the hospital stay was decreased, and the recovery was enhanced. This indicates that ministernotomy is technically feasible and may be a good alternative procedure in the surgical treatment of aortic valve lesions.

Traditionally, standard aortic valve replacement

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