Minimally invasive versus conventional aortic valve replacement: a prospective randomized trial.
OBJECTIVE
A prospective randomized study was performed to compare conventional with minimally invasive aortic valve replacement (AVR).


METHODS
Forty consecutive patients scheduled for elective aortic valve surgery were prospectively randomized either to the conventional group (group A, complete median sternotomy) or minimally invasive group (group B, partial upper sternotomy). Intraoperative and postoperative clinical data, and markers of myocardial and cerebral protection were determined. Neuropsychological tests were carried out to quantify psychological disorders.


RESULTS
Operative time and cardiopulmonary bypass time were slightly longer in group B, but not significantly so. No significant inter-group differences were found for postoperative pain scores and respiratory function. Chest tube drainage was significantly less in group B (495 +/- 165 versus 240 +/- 69 ml, p = 0.008). Creatine kinase (CK), CK-MB and troponin T levels were similar in both groups. Neither S-100B protein nor neuron-specific enolase levels differed significantly between groups at all sampling times. There were no strokes in the entire cohort. None of the neuropsychological tests yielded significant inter-group differences between conventional and minimally invasive surgery.


CONCLUSIONS
The safety and reliability of AVR via a partial upper sternotomy is reported. Minimally invasive AVR can be performed with only slightly longer operative times, good cosmetic results and significantly less blood loss. A limited surgical access affected neither the patients' neurological outcome nor the efficacy of myocardial protection.
Dogan
Selami
S
Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany.
Dzemali
Omer
O
Wimmer-Greinecker
Gerhard
G
Derra
Patrick
P
Doss
Mirko
M
Khan
Mohammad F
MF
Aybek
Tayfun
T
Kleine
Peter
P
Moritz
Anton
A
D001022:Aortic Valve Insufficiency / Q000097:blood / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000097:blood / Q000601:surgery*; D016063:Blood Loss, Surgical; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors; D011446:Prospective Studies; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood; D020107:Troponin T / Q000097:blood
D007527:Isoenzymes; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; D020107:Troponin T; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form