title: Comparison of Anterolateral Minithoracotomy Versus Partial Upper Hemisternotomy in Aortic Valve Replacement.
abstract: BACKGROUND
  In aortic valve replacement, a comparison between the anterolateral minithoracotomy and the partial upper hemisternotomy approach has not been reported to date.
  
  
  METHODS
  From 2006 to 2012, isolated aortic valve replacement was performed in 1,118 consecutive patients. Aortic valve replacement was performed through a anterolateral minithoracotomy in 166 patients (14.9%) and through a partial upper hemisternotomy in 245 patients (21.9%). A propensity score-matched analysis was performed in 160 matched pairs.
  
  
  RESULTS
  Conversion to median sternotomy was significantly higher in the anterolateral group (n = 22, 13.1%) than in the hemisternotomy group (n = 7, 4.4%) (p = 0.004). A second cross-clamp was significantly more often necessary in the anterolateral group (n = 14, 8.8%) than in the hemisternotomy group (n =2, 1.3%) (p = 0.003). The median cross-clamp time was significantly longer in the anterolateral group, 93 minutes (range, 43 to 231 minutes) than in the hemisternotomy group, 75 minutes (range, 46 to 137 minutes) (p < 0.0001). The median perfusion time was significantly longer in the anterolateral group, 137 minutes (range, 81 to 456 minutes) than in the hemisternotomy group, 113 minutes (range, 66 to 257 minutes) (p < 0.0001). Significantly more groin adverse events occurred in the anterolateral group (n = 17, 10.8%) than in the hemisternotomy group (n = 0, 0%) (p < 0.0001). No significant difference in 90-day mortality was seen in the anterolateral group (n = 6, 3.8%) than in the hemisternotomy group (n = 2, 1.3%) (p = 0.16).
  
  
  CONCLUSIONS
  The anterolateral minithoracotomy is associated with more perioperative adverse events. The partial upper hemisternotomy is an excellent surgical technique for minimally invasive aortic valve replacement in the daily routine for every staff surgeon.
authors.affiliation: Department of Cardiac Surgery, Center of Operative Medicine, Innsbruck Medical University, Austria. Electronic address: severin.semsroth@i-med.ac.at.
authors.forename: Severin
authors.initials: S
authors.lastname: Semsroth
authors.affiliation: Department of Public Health and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
authors.forename: Raffaela
authors.initials: R
authors.lastname: Matteucci-Gothe
authors.affiliation: Department of Cardiac Surgery, Center of Operative Medicine, Innsbruck Medical University, Austria.
authors.forename: Anneliese
authors.initials: A
authors.lastname: Heinz
authors.affiliation: Tumor Registry South Tyrol, Bolzano, Italy.
authors.forename: Thomas
authors.initials: T
authors.lastname: Dal Capello
authors.affiliation: Department of Cardiac Surgery, Center of Operative Medicine, Innsbruck Medical University, Austria.
authors.forename: Juliane
authors.initials: J
authors.lastname: Kilo
authors.affiliation: Department of Cardiac Surgery, Center of Operative Medicine, Innsbruck Medical University, Austria.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Müller
authors.affiliation: Department of Cardiac Surgery, Center of Operative Medicine, Innsbruck Medical University, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
authors.affiliation: Department of Cardiac Surgery, Center of Operative Medicine, Innsbruck Medical University, Austria.
authors.forename: Elfriede
authors.initials: E
authors.lastname: Ruttman-Ulmer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*