title: Manubrium-limited sternotomy decreases blood loss after aortic valve replacement surgery.
abstract: OBJECTIVE
  Minimally invasive surgical approaches for aortic valve replacement (AVR) are growing in popularity in an attempt to decrease morbidity from conventional surgery. We have adopted a technique that divides only the manubrium and spares the body of the sternum. We sought to determine whether patients benefit from this less-invasive approach.
  
  
  METHODS
  We retrospectively analysed our prospectively maintained database to review all isolated aortic valve replacements performed in an 18-month period from November 2011 to April 2013.
  
  
  RESULTS
  One hundred and ninety-one patients were identified, 98 underwent manubrium-limited sternotomy (Mini-AVR) and 93 had a conventional median sternotomy (AVR). The two groups were well matched for preoperative variables and risk (mean logistic EuroSCORE mini-AVR 7.15 vs AVR 6.55, P = 0.47). Mean cardiopulmonary bypass and aortic cross-clamp times were 10 and 6 min longer, respectively, in the mini-AVR group (mean values 88 vs 78 min, P = 0.00040, and 66 vs 60 min, P = 0.0078, respectively). Mini-AVR patients had significantly less postoperative blood loss, 332 vs 513 ml, P = 0.00021, and were less likely to require blood products (fresh-frozen plasma and platelets), 24 vs 36%, P = 0.042. Postoperative complications and length of stay were similar (discharge on or before Day 4; mini-AVR 15 vs AVR 8%, P = 0.17). Valve outcome (paravalvular leak mini-AVR 2 vs AVR 1%, P = 1.00) and survival (mini-AVR 99 vs AVR 97%, P = 0.36) were equal.
  
  
  CONCLUSIONS
  A manubrium-limited approach maintains outcomes achieved for aortic valve replacement by conventional sternotomy while significantly reducing postoperative blood loss and transfusion of blood products.
authors.affiliation: Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough UK.
authors.forename: Clare L
authors.initials: CL
authors.lastname: Burdett
authors.affiliation: Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough UK.
authors.forename: Ignacio Bibiloni
authors.initials: IB
authors.lastname: Lage
authors.affiliation: Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough UK.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Goodwin
authors.affiliation: Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough UK.
authors.forename: Ralph W
authors.initials: RW
authors.lastname: White
authors.affiliation: Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough UK.
authors.forename: Khalid J
authors.initials: KJ
authors.lastname: Khan
authors.affiliation: Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough UK.
authors.forename: W Andrew
authors.initials: WA
authors.lastname: Owens
authors.affiliation: Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough UK.
authors.forename: Simon W H
authors.initials: SW
authors.lastname: Kendall
authors.affiliation: Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough UK.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Ferguson
authors.affiliation: Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough UK.
authors.forename: Joel
authors.initials: J
authors.lastname: Dunning
authors.affiliation: Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough UK enoch.akowuah@nhs.net.
authors.forename: Enoch F
authors.initials: EF
authors.lastname: Akowuah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008371:Manubrium / Q000601:surgery*; D008875:Middle Aged; D010949:Plasma; D017713:Platelet Transfusion; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aortic; Minimally invasive surgery; Valve disease