title: Prospective randomized study of early pulmonary evaluation of patients scheduled for aortic valve surgery performed by ministernotomy or total median sternotomy.
abstract: OBJECTIVE
  The purpose of this study was to compare the respiratory function of patients operated either with a ministernotomy or with a conventional sternotomy for an aortic valve replacement.
  
  
  METHODS
  A prospective randomized study.
  
  
  METHODS
  A single-institution university hospital.
  
  
  METHODS
  Seventy-eight patients scheduled for aortic valve replacement.
  
  
  METHODS
  Patients were assigned to have minimal sternotomy access (ministernotomy) or conventional median total sternotomy. Pulmonary function was measured using a mobile respiratory spirometric device preoperatively and after 1 (POD1), 2 (POD2), and 7 days (POD7) postoperatively.
  
  
  RESULTS
  There was no significant difference in any respiratory parameter measured between the 2 groups of patients. Almost all respiratory volumes decreased significantly with the same intensity in the 2 groups on POD1 (p <0.05), by about 50% from baseline. Only functional residual capacity was unchanged from baseline in the postoperative period, except for a small but significant reduction of this parameter to 60.3% +/- 27.4% in the standard sternotomy group on POD1 and 60.9% +/- 27.1% and 58.8% +/- 30.4%, respectively, in the ministernotomy and the standard group at POD7. The only significant difference concerned the intraoperative blood loss measured at 450 +/- 280 mL and 720 +/- 450 mL, respectively, in the ministernotomy and the standard group (p < 0.05), but this was not significantly associated with a reduction of total blood use.
  
  
  CONCLUSIONS
  This study failed to show any improvement of respiratory function by a smaller chest incision. However, it showed a significant reduction in intraoperative bleeding but without a reduction in transfusion. Further investigations are required to assess whether this procedure could improve the outcome of cardiac surgery patients with a greater predicted risk score or pulmonary diseases.
authors.affiliation: Service of Anesthesiology and Intensive Care II, Pr Gérard Janvier, Cardiologic Hospital of Haut-Lévêque, University Hospital of Bordeaux, Pessac, France. joachim.calderon@chu-bordeaux.fr
authors.forename: Joachim
authors.initials: J
authors.lastname: Calderon
authors.forename: Philippe
authors.initials: P
authors.lastname: Richebe
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Guibaud
authors.forename: Alain
authors.initials: A
authors.lastname: Coiffic
authors.forename: Olivier
authors.initials: O
authors.lastname: Branchard
authors.forename: Julien
authors.initials: J
authors.lastname: Asselineau
authors.forename: Gérard
authors.initials: G
authors.lastname: Janvier
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D011446:Prospective Studies; D012129:Respiratory Function Tests; D013147:Spirometry; D056346:Sternotomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome