title: Minimally invasive aortic valve replacement: late conversion to full sternotomy doubles operative time.
abstract: In this descriptive prospective study, we evaluate the outcomes of surgery in 98 patients who were scheduled to undergo minimally invasive aortic valve replacement. These patients were compared with a group of 50 patients who underwent scheduled aortic valve replacement through a full sternotomy. The 30-day mortality rate for the 98 patients was zero, although 14 of the 98 mini-sternotomies had to be converted to complete sternotomies intraoperatively due to technical problems. Such conversion doubled the operative time over that of the planned full sternotomies. In the group of patients whose operations were completed as mini-sternotomies, 4 died later of noncardiac causes. The aortic cross-clamp and perfusion times were significantly different across all groups (P < 0.001), with the intended full-sternotomy group having the shortest times. In conclusion, the mini-aortic valve replacement is an excellent operation in selected patients, but its true advantages over conventional aortic valve replacement (other than a smaller scar) await evaluation by means of randomized clinical trial. The "extended mini-aortic valve replacement" operation, on the other hand, is a risky procedure that should be avoided by better preoperative evaluation of patients. In any event, the decision to extend a mini-sternotomy to a full sternotomy should be made early in the course of operation, before cardiopulmonary bypass is instituted.
authors.affiliation: Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Signe
authors.initials: S
authors.lastname: Foghsgaard
authors.forename: Thomas Andersen
authors.initials: TA
authors.lastname: Schmidt
authors.forename: Henrik K
authors.initials: HK
authors.lastname: Kjaergard
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D018579:Patient Selection; D011446:Prospective Studies; D018570:Risk Assessment; D013249:Sternum / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
references.citation: Anesth Analg. 1996 Dec;83(6):1342-4
references.pmid: 8942613
references.citation: Acta Chir Belg. 2004 Aug;104(4):440-4
references.pmid: 15469158
references.citation: Thorac Cardiovasc Surg. 2002 Dec;50(6):337-41
references.pmid: 12457309
references.citation: Curr Opin Cardiol. 2000 Mar;15(2):91-5
references.pmid: 10963145
references.citation: Ann Thorac Surg. 2002 Feb;73(2):460-5; discussion 465-6
references.pmid: 11845860
references.citation: Acta Cardiol. 2003 Feb;58(1):17-21
references.pmid: 12625490
references.citation: Cardiovasc Surg. 2002 Aug;10(4):333-8
references.pmid: 12359403
references.citation: J Card Surg. 2003 Sep-Oct;18(5):396-401; discussion 402-3
references.pmid: 12974924
references.citation: J Thorac Cardiovasc Surg. 1983 Dec;86(6):845-57
references.pmid: 6606084
references.citation: Ann Surg. 2004 Sep;240(3):529-34; discussion 534
references.pmid: 15319724
references.citation: J Card Surg. 2000 Jan-Feb;15(1):3-5
references.pmid: 11204385
references.citation: Eur J Cardiothorac Surg. 1998 Oct;14 Suppl 1:S130-3
references.pmid: 9814809
references.citation: Ann Thorac Surg. 2006 May;81(5):1599-604
references.pmid: 16631641
references.citation: J Heart Valve Dis. 2004 Nov;13(6):887-93
references.pmid: 15597578