title: Non-sutureless minimally invasive aortic valve replacement: mini-sternotomy versus mini-thoracotomy: a series of 1130 patients.
abstract: Aortic valve replacement through conventional sternotomy still represents the gold-standard surgical approach for aortic valve disease. However, given the increasing number of patients with comorbidities, strategies that can improve operative results are always sought. Minimally invasive aortic valve surgery, although related to a steep learning curve, might be associated with improved postoperative outcomes. The main aim of this study was to assess whether significant differences exist in terms of operative and early results between a mini-sternotomy and a right mini-thoracotomy approach for isolated aortic valve replacement without sutureless technologies.
  
  
  
  This is an observational retrospective multicentre study from nine Italian cardiac centres that analyses prospectively collected data of patients who underwent isolated minimally invasive aortic valve replacement between January 2010 and December 2014. Two approaches are considered (mini-sternotomy and mini-thoracotomy) and compared in terms of operative and early outcomes.
  
  
  
  After interrogation of the centralized database, a total of 1130 patients were retrieved (854 mini-sternotomy and 276 mini-thoracotomy). Patients in the mini-sternotomy group had a higher risk profile. There was no difference in terms of early mortality; cardiopulmonary bypass and cross-clamp time did not differ significantly between the groups; and a significantly higher number of reoperations for bleeding was observed in the right mini-thoracotomy group.
  
  
  
  Both mini-sternotomy and mini-thoracotomy could be performed safely, with low mortality and postoperative morbidity. The mini-thoracotomy approach was associated with a significantly higher rate of reoperation for bleeding. Uptake among cardiac centres was low. Sutureless technologies could potentially increase surgical volume by simplifying the mini-thoracotomy procedure.
authors.affiliation: Department of Surgery and Cancer, University of Palermo, Italy Department of Cardiothoracic and vascular Surgery, GVM Care and Research, Villa Maria Eleonora, Palermo, Italy.
authors.forename: Khalil
authors.initials: K
authors.lastname: Fattouch
authors.affiliation: National Heart and Lung Institute, Imperial College, London, UK m.moscarelli@imperial.ac.uk.
authors.forename: Marco
authors.initials: M
authors.lastname: Moscarelli
authors.affiliation: Department of Cardiac Surgery, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Del Giglio
authors.affiliation: Department of Cardiac Surgery, GVM Care and Research, Salus Hospital, Ravenna, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Albertini
authors.affiliation: Department of Cardiac Surgery, GVM Care and Research, Maria Pia Hospital, Torino, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Comoglio
authors.affiliation: Department of Cardiac Surgery, GVM Care and Research, Istituto Clinico Ligure Alta Specialita', Rapallo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Coppola
authors.affiliation: Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nasso
authors.affiliation: Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Speziale
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods*; D013536:Suture Techniques; D013908:Thoracotomy / Q000379:methods
keywords: Aortic valve replacement; Exposure; Incision; Minimally invasive surgery; Surgery; Technique