Right Anterior Minithoracotomy Versus Conventional Median Sternotomy for Aortic Valve Replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANGZhao-lei ¹ ,  MEIJu ¹ , DINGFang-bao ¹ , ZHANGYun-jiao ¹ , LIUHao ¹ , ZHANGJun-wen ¹ , SHENSai-e ² , YINHang ¹

1. Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, P. R. China;
2. Department of Anesthesiology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, P. R. China;

Corresponding author：

MEIJu, Email: ju_mei63@126.com

Keywords：

Minimally invasive surgery; Aortic valve replacement; Right anterior minithoracotomy

DOI：

10.7507/1007-4848.20140218

Video：

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Objective To compare the safety and clinical outcomes of isolated aortic valve replacement (AVR)through right anterior minithoracotomy (RAMT)and conventional median sternotomy. Methods From March 2006 to March 2013, 169 patients underwent isolated AVR in Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine. Among them, 42 patients received AVR via RAMT (RAMT group)including 30 males and 12 females with their age of 59.31±8.30 years. And 127 patients received AVR via conventional median sternotomy (conventional surgery group)including 89 males and 38 females with their age of 60.02±5.93 years. There were 75 patients with aortic valve stenosis (AS), 42 patients with aortic regurgitation (AR)and 52 patients with AS+AR. Postoperative outcomes were compared between the 2 groups. Results There was no statistical difference in preoperative clinical characteristics between the 2 groups. All the patients successfully received isolated AVR. 153 patients received mechanical prosthesis and 16 patients received bioprosthetic valves. Fifty-two patients received 21 mm valves, and 117 patients received 23 mm valves. Cardiopulmonary bypass time and aortic cross-clamping time of RAMT group were significantly longer than those of conventional surgery group (P < 0.001). But mechanical ventilation time, length of postoperative ICU stay and hospital stay of RAMT group were significantly shorter than those of conventional surgery group (P < 0.001). Postoperative thoracic drainage, intraoperative and postoperative blood transfusion of RAMT group were significantly less than those of conventional surgery group (P < 0.001). In conventional surgery group, 2 patients underwent reexploration for bleeding and 2 patients had wound infection postoperatively. Two patients died postoperatively, both in conventional surgery group, including 1 patient with low cardiac output syndrome and multiple organ dysfunction syndrome, and another patient with prosthetic valve endocarditis secondary to sternal wound infection. Conclusion Compared with conventional median sternotomy, RAMT is safe and efficacious for patients undergoing isolated AVR with minimal surgical injury, better postoperative recovery and cosmetic outcomes.

Citation： JIANGZhao-lei, MEIJu, DINGFang-bao, ZHANGYun-jiao, LIUHao, ZHANGJun-wen, SHENSai-e, YINHang. Right Anterior Minithoracotomy Versus Conventional Median Sternotomy for Aortic Valve Replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 762-765. doi: 10.7507/1007-4848.20140218 Copy

1.	Miceli A, Murzi M, Gilmanov D, et al. Minimally invasive aortic valve replacement using right minithoracotomy is associated with better outcomes than ministernotomy. J Thorac Cardiovasc Surg, 2014, 148(1):133-137.
2.	尤斌, 高峰, 李平, 等.微创直视主动脉瓣替换术和传统开胸手术的比较.中华医学杂志, 2012, 92(40):2859-2861.
3.	Totsugawa T, Kuinose M, Hiraoka A, et al. Anterolateral approach for minimally invasive aortic valve replacement. Gen Thorac Cardiovasc Surg, 2014, 62(5):290-295.
4.	Byrne JG, Karavas AN, Adams DH, et al. Partial upper re-sternotomy for aortic valve replacement or re-replacement after previous cardiac surgery. Eur J Cardiothorac Surg, 2000, 18(3):282-286.
5.	Raja SG, Benedetto U. Minimal access aortic valve replacement via limited skin incision and complete median sternotomy. J Thorac Dis, 2013, 5(Suppl 6):S654-S657.
6.	Yilmaz A, Sjatskig J, van Boven WJ, et al. J-shaped versus median sternotomy for aortic valve replacement with minimal extracorporeal circuit. Scand Cardiovasc J, 2011, 45(6):379-384.
7.	Alassar Y, Yildirim Y, Pecha S, et al. Minimal access median sternotomy for aortic valve replacement in elderly patients. J Cardiothorac Surg, 2013, 8:103.
8.	Johnston WF, Ailawadi G. Surgical management of minimally invasive aortic valve operations. Semin Cardiothorac Vasc Anesth, 2012, 16(1):41-51.
9.	Gilmanov D, Bevilacqua S, Murzi M, et al. Minimally invasive and conventional aortic valve replacement:a propensity score analysis. Ann Thorac Surg, 2013, 96(3):837-843.
10.	Fortunato Júnior JA, Fernandes AG, Sesca JR, et al. Minimally invasive aortic valve replacement:an alternative to the conventional technique. Rev Bras Cir Cardiovasc, 2012, 27(4):570-582.
11.	张建卿, 苑星, 肖明弟, 等.电视胸腔镜辅助微创在主动脉瓣置换术中的应用.中国心血管病研究, 2011, 9(11):844-847.
12.	Paredes FA, Cánovas SJ, Gil O, et al. Minimally invasive aortic valve surgery. A safe and useful technique beyond the cosmetic benefits. Rev Esp Cardiol, 2013, 66(9):695-699.
13.	沈金强, 魏来, 夏利民, 等.微创主动脉瓣置换术101例临床分析.中华外科杂志, 2013, 51(3):252-255.
14.	Malaisrie SC, Barnhart GR, Farivar RS, et al. Current era minimally invasive aortic valve replacement:techniques and practice. J Thorac Cardiovasc Surg, 2014, 147(1):6-14.
15.	Glauber M, Miceli A, Gilmanov D, et al. Right anterior minithoracotomy versus conventional aortic valve replacement:a propensity score matched study. J Thorac Cardiovasc Surg, 2013, 145(5):1222-1226.
16.	高峰, 尤斌, 李平, 等.微创主动脉瓣置换术及术后早期结果.中华胸心血管外科杂志, 2012, 28(6):349-351.
17.	Rodríguez JE, López MJ, Carrascal Y, et al. Aortic valve replacement via ministernotomy. Rev Esp Cardiol, 1996, 49(12):928-930.
18.	金海, 徐志云, 于伟勇, 等.微创小切口心脏瓣膜手术134例.中国胸心血管外科临床杂志, 2005, 12(4):237-239.
19.	Murtuza B, Pepper JR, Stanbridge RD, et al. Minimal access aortic valve replacement:is it worth it? Ann Thorac Surg, 2008, 85(3):1121-1131.
20.	王立成, 陈红卫, 杨斌, 等.主动脉瓣病变伴根部严重狭小的外科治疗.中国心血管病研究杂志, 2008, 6(9):680-681.

1. Miceli A, Murzi M, Gilmanov D, et al. Minimally invasive aortic valve replacement using right minithoracotomy is associated with better outcomes than ministernotomy. J Thorac Cardiovasc Surg, 2014, 148(1):133-137.
2. 尤斌, 高峰, 李平, 等.微创直视主动脉瓣替换术和传统开胸手术的比较.中华医学杂志, 2012, 92(40):2859-2861.
3. Totsugawa T, Kuinose M, Hiraoka A, et al. Anterolateral approach for minimally invasive aortic valve replacement. Gen Thorac Cardiovasc Surg, 2014, 62(5):290-295.
4. Byrne JG, Karavas AN, Adams DH, et al. Partial upper re-sternotomy for aortic valve replacement or re-replacement after previous cardiac surgery. Eur J Cardiothorac Surg, 2000, 18(3):282-286.
5. Raja SG, Benedetto U. Minimal access aortic valve replacement via limited skin incision and complete median sternotomy. J Thorac Dis, 2013, 5(Suppl 6):S654-S657.
6. Yilmaz A, Sjatskig J, van Boven WJ, et al. J-shaped versus median sternotomy for aortic valve replacement with minimal extracorporeal circuit. Scand Cardiovasc J, 2011, 45(6):379-384.
7. Alassar Y, Yildirim Y, Pecha S, et al. Minimal access median sternotomy for aortic valve replacement in elderly patients. J Cardiothorac Surg, 2013, 8:103.
8. Johnston WF, Ailawadi G. Surgical management of minimally invasive aortic valve operations. Semin Cardiothorac Vasc Anesth, 2012, 16(1):41-51.
9. Gilmanov D, Bevilacqua S, Murzi M, et al. Minimally invasive and conventional aortic valve replacement:a propensity score analysis. Ann Thorac Surg, 2013, 96(3):837-843.
10. Fortunato Júnior JA, Fernandes AG, Sesca JR, et al. Minimally invasive aortic valve replacement:an alternative to the conventional technique. Rev Bras Cir Cardiovasc, 2012, 27(4):570-582.
11. 张建卿, 苑星, 肖明弟, 等.电视胸腔镜辅助微创在主动脉瓣置换术中的应用.中国心血管病研究, 2011, 9(11):844-847.
12. Paredes FA, Cánovas SJ, Gil O, et al. Minimally invasive aortic valve surgery. A safe and useful technique beyond the cosmetic benefits. Rev Esp Cardiol, 2013, 66(9):695-699.
13. 沈金强, 魏来, 夏利民, 等.微创主动脉瓣置换术101例临床分析.中华外科杂志, 2013, 51(3):252-255.
14. Malaisrie SC, Barnhart GR, Farivar RS, et al. Current era minimally invasive aortic valve replacement:techniques and practice. J Thorac Cardiovasc Surg, 2014, 147(1):6-14.
15. Glauber M, Miceli A, Gilmanov D, et al. Right anterior minithoracotomy versus conventional aortic valve replacement:a propensity score matched study. J Thorac Cardiovasc Surg, 2013, 145(5):1222-1226.
16. 高峰, 尤斌, 李平, 等.微创主动脉瓣置换术及术后早期结果.中华胸心血管外科杂志, 2012, 28(6):349-351.
17. Rodríguez JE, López MJ, Carrascal Y, et al. Aortic valve replacement via ministernotomy. Rev Esp Cardiol, 1996, 49(12):928-930.
18. 金海, 徐志云, 于伟勇, 等.微创小切口心脏瓣膜手术134例.中国胸心血管外科临床杂志, 2005, 12(4):237-239.
19. Murtuza B, Pepper JR, Stanbridge RD, et al. Minimal access aortic valve replacement:is it worth it? Ann Thorac Surg, 2008, 85(3):1121-1131.
20. 王立成, 陈红卫, 杨斌, 等.主动脉瓣病变伴根部严重狭小的外科治疗.中国心血管病研究杂志, 2008, 6(9):680-681.

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Right Anterior Minithoracotomy Versus Conventional Median Sternotomy for Aortic Valve Replacement

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