title: Aortic valve replacement through full sternotomy with a stented bioprosthesis versus minimally invasive sternotomy with a sutureless bioprosthesis.
abstract: OBJECTIVE
  The aim of this study was to analyse early postoperative outcomes and 2-year survival after aortic valve replacement (AVR) through a ministernotomy with a sutureless bioprosthesis implantation compared with a full sternotomy with implantation of a stented bioprosthesis.
  
  
  METHODS
  Patients who underwent primary isolated non-emergent AVR at six European centres were included in the study. Of these, 182 (32%) underwent a ministernotomy with a sutureless bioprosthesis (ministernotomy sutureless group) and 383 (68%) a full sternotomy with a stented bioprosthesis (full sternotomy stented group). Propensity score matching was used to reduce selection bias.
  
  
  RESULTS
  In the overall cohort, 30-day mortality was 1.6 and 2.1%, and 2-year survival was 92 and 92% in the ministernotomy sutureless group and in the full sternotomy stented group, respectively. Propensity score matching resulted in 171 pairs with similar characteristics and operative risk. Aortic cross-clamp (40 vs 65 min, P < 0.001) and cardiopulmonary bypass time (69 vs 87 min, P < 0.001) were shorter in the ministernotomy sutureless group. Patients undergoing ministernotomy received less packed red blood cells but the risk for postoperative permanent pacemaker implantation was higher. There were no differences regarding 30-day mortality or 2-year survival between the two groups.
  
  
  CONCLUSIONS
  AVR through a ministernotomy with implantation of a sutureless bioprosthesis was associated with shorter aortic cross-clamp and cardiopulmonary bypass time and less transfusion of packed red blood cells, but a higher risk for postoperative permanent pacemaker implantation compared with a full sternotomy with a stented bioprosthesis.
authors: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden magnus.dalen@karolinska.se.
authors: Magnus
authors: M
authors: Dalén
authors: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: Fausto
authors: F
authors: Biancari
authors: Cardiac Surgery Unit, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
authors: Antonino S
authors: AS
authors: Rubino
authors: Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.
authors: Giuseppe
authors: G
authors: Santarpino
authors: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.
authors: Natalie
authors: N
authors: Glaser
authors: Department of Cardiac Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
authors: Herbert
authors: H
authors: De Praetere
authors: Department of Cardiac Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
authors: Keiichiro
authors: K
authors: Kasama
authors: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: Tatu
authors: T
authors: Juvonen
authors: Cardiac Surgery Unit, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
authors: Wanda
authors: W
authors: Deste
authors: Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.
authors: Francesco
authors: F
authors: Pollari
authors: Department of Cardiac Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
authors: Bart
authors: B
authors: Meuris
authors: Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.
authors: Theodor
authors: T
authors: Fischlein
authors: Cardiac Surgery Unit, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
authors: Carmelo
authors: C
authors: Mignosa
authors: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors: Giuseppe
authors: G
authors: Gatti
authors: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors: Aniello
authors: A
authors: Pappalardo
authors: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.
authors: Peter
authors: P
authors: Svenarud
authors: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.
authors: Ulrik
authors: U
authors: Sartipy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D017063:Outcome Assessment, Health Care; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods* / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Aortic valve replacement; Minimally invasive surgery; Ministernotomy; Sutureless