title: Upper 'J' ministernotomy versus full sternotomy: an easier approach for aortic valve reoperation.
abstract: OBJECTIVE
  Aortic valve replacement (AVR) after previous cardiac surgery is usually associated with an increased risk profile. The study aim was to compare the outcome after AVR through an upper 'J' ministernotomy compared to a standard full sternotomy approach in a redo operation.
  
  
  METHODS
  A total of 90 patients who underwent reoperative AVR at the authors' institution between October 2007 and January 2012 was retrospectively reviewed. Of these patients, 46 had patent bypass grafts and 44 previously had heart valve replacement or repair. Sixteen patients had endocarditis as the etiology, and 14 had prosthetic valve endocarditis. Of the 90 patients operated on, a minimally invasive upper 'J' ministernotomy was performed in 38, and a full median sternotomy in 52. The median age was 76 years (25th percentile 68.25 years; 75th percentile 79.25 years) for the minimally invasive group, and 73.5 (25th percentile 68 years; 75th percentile 78.75 years) for the full sternotomy group (p = 0.945). No statistically significant differences in terms of body mass index (p = 0.987), left ventricular ejection fraction (p = 0.544) and EuroSCORE (p = 0.162) were found between the two groups. Intraoperative data and postoperative outcomes, in terms of intensive care unit stay, blood loss, transfusions and sternal complications were analyzed.
  
  
  RESULTS
  All patients underwent AVR. The median (IQR) cardiopulmonary bypass and cross-clamp times were respectively 67 (28) min and 51 (28) min for the minimally invasive group, and 72 (47) min and 53.5 (28) min for the full sternotomy group (p = 0.686 and p = 0.993). The postoperative ventilation time was significantly less in ministernotomy patients (median 6 versus 8.5 h; p = 0.027). One patient affected by endocarditis died in the minimally invasive group (mortality rate 2.6%). Hospital mortality in the traditional group was 3/52 (5.8%).
  
  
  CONCLUSIONS
  Minimally invasive aortic valve surgery reoperation through an upper 'J' sternotomy proved to be at least as safe as the standard procedure in terms of hospital morbidity and mortality rates.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM for Care & Research, ES Health Science Foundation, Cotignola (RA), Italy. elisamikus@yahoo.it
authors.forename: Elisa
authors.initials: E
authors.lastname: Mikus
authors.forename: Simone
authors.initials: S
authors.lastname: Calvi
authors.forename: Alberto
authors.initials: A
authors.lastname: Tripodi
authors.forename: Mauro
authors.initials: M
authors.lastname: Lamarra
authors.forename: Mauro
authors.initials: M
authors.lastname: Del Giglio
mesh_terms: D000368:Aged; D057186:Comparative Effectiveness Research; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007558:Italy; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods / Q000401:mortality; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome