[Ministernotomy improves the postoperative course in aortic valve replacement].
BACKGROUND
The advantages and the safety aspects of ministernotomy, in aortic valve replacement, are presently under investigation. The aim of this study was to compare the postoperative results between ministernotomy access and standard total sternotomy access.


METHODS
Between January 1997 and July 2002, 98 patients underwent elective aortic valve replacement. They were divided into two groups: group Gm (49 patients) undergoing a ministernotomy approach ("reversed C" or "reversed L") and group Gs (49 patients) undergoing conventional total sternotomy.


RESULTS
The length of the skin incision was significantly shorter in group Gm (p < 0.001). The total operative time was significantly longer in group Gm (p = 0.02), but no significant differences were found in the cardiopulmonary bypass and aortic cross-clamping times. Mean mediastinal drainage, incidence of bleeding > 800 ml, mechanical ventilation time, intensive care unit stay and hospital stay were significantly greater in group Gs. Five days after the surgical procedure, spirometric analysis demonstrated a significant reduction in total lung capacity, and in maximum expiratory and inspiratory pressures in group Gs compared with group Gm (p = 0.003, p = 0.001, p = 0.01, respectively).


CONCLUSIONS
Our results showed that in addition to cosmetic advantages, ministernotomy is also associated with a better outcome in terms of sternal stability, blood loss and transfusions, and postoperative pain. Ministernotomy also improved the recovery of respiratory function, with a shorter mechanical ventilation time and allowed an earlier hospital discharge.
Bonacchi
Massimo
M
Cattedra e Scuola di Specializzazione in Cardiochirurgia, Università degli Studi, Viale Morgagni, 85 50134 Firenze. mbonacchi@hotmail.com
Maiani
Massimo
M
Battaglia
Francesco
F
Prifti
Edvin
E
Giunti
Gabriele
G
Campisi
Salvatore
S
Sani
Guido
G
D001021:Aortic Valve; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013249:Sternum / Q000601:surgery*