Mini Sternotomy and Mini Thoracotomy for Aortic Valve Replacement: Is There a Difference?

ABSTRACT

BACKGROUND: Minimally invasive valve replacement is increasingly accepted among surgeons and patients alike. Ministernotomy and minithoracotomy are the most used incisions in the minimally aortic valve replacement. The superiority of one incision over the other still is debatable with a few centers having the opportunity to compare them head-to-head. METHODS: A retrospective analysis of 260 patients, who underwent mini AVR, with 132 patients in the ministernotomy group and 128 patients in the minithoracotomy group. Operative details, mortality, wound cosmetics, and postoperative pain were among the primary end points. RESULTS: A predominance of female gender has been observed in both groups. The cross-clamp and total bypass times were significantly lower in MS compared with the MT approach (63.61±16.115 vs. 70.75±33.274 min, P = 0.028, and 91.90±26.365 vs. 112.24±51.634 min, P < 0.001, respectively). The minithoracotomy group had significantly shorter lengths of wounds (5.1 ± 0.6 vs. 8.48±0.344 cm, P < 0.001). The ministernotomy group had significantly lower postoperative pain scores either in the ICU, at hospital discharge, or after 30 days at the outpatient clinic, where scores compared with MT (4.46±1.23 vs. 5.23±1.12, P < 0.001, 1.6±0.84 vs. 1.83±0.72, P = 0.019, and 1.28±0.67 vs. 1.47±0.53, P = 0.012, respectively). CONCLUSION: Both minimally invasive incisions for AVR proved their safety and efficacy. While the ministernotomy has the advantage of less postoperative pain and pleural complications, the minithoracotomy incision has its unmatched aesthetic appeal.