title: J-shaped versus median sternotomy for aortic valve replacement with minimal extracorporeal circuit.
abstract: OBJECTIVE
  Minimal access aortic valve replacement (AVR) has been demonstrated to have beneficial effects over median sternotomy. Minimal extracorporeal circulation (MECC) has been shown to have less deleterious effects than conventional cardiopulmonary bypass. We describe for the first time AVR via upper J-shaped partial sternotomy compared to median sternotomy using MECC.
  
  
  METHODS
  Prospectively collected pre-operative, intra-operative, post-operative and follow-up data from 104 consecutive patients who underwent minimal access AVR were compared to 72 consecutive patients undergoing median sternotomy using MECC during the same period (January 2007 to December 2009).
  
  
  RESULTS
  No significant differences were found in patient's characteristics or intra-operative data with the exception of pre-existing pulmonary disease. The mean cardiopulmonary bypass (86 ± 18 min vs. 78 ± 15 min, p = 0.0079) and cross-clamp times (65 ± 13 min vs. 59 ± 12 min, p = 0.0013) were significantly shorter in the median sternotomy group. Mediastinal blood loss (397 ± 257 ml vs. 614 ± 339 ml, p < 0.0001) and ventilation time (8 ± 6.9 h vs. 11 ± 16.5 h, p = 0.0054) were significantly less in the minimal access group. No differences were seen in transfusion requirements, inotropic support, intensive care unit (ICU) stay, total hospital stay, post-operative haemoglobin drop, major events or mortality. Quality of life scores after discharge demonstrated less pain with a quicker recovery and return to daily activities in patients receiving J-shaped sternotomy.
  
  
  CONCLUSIONS
  Minimal access AVR using MECC is feasible and provides excellent clinical results. Less pain and quicker recovery was experienced among patients in this group.
authors.affiliation: Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Alaaddin
authors.initials: A
authors.lastname: Yilmaz
authors.forename: Jelena
authors.initials: J
authors.lastname: Sjatskig
authors.forename: Wim J
authors.initials: WJ
authors.lastname: van Boven
authors.forename: Frans G
authors.initials: FG
authors.lastname: Waanders
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Kelder
authors.forename: Uday
authors.initials: U
authors.lastname: Sonker
authors.forename: Geoffrey T L
authors.initials: GT
authors.lastname: Kloppenburg
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D016009:Chi-Square Distribution; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012121:Respiration, Artificial; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome