Open AccessEarly and midterm results of upper ministernotomy approach for aortic valve replacement
Author(s) -
I. Moursi,
K. Al Fakharany
Publication year - 2017
Publication title -
journal of the egyptian society of cardio-thoracic surgery
Language(s) - English
Resource type - Journals
eISSN - 2524-1745
pISSN - 1110-578X
DOI - 10.1016/j.jescts.2017.11.001
Subject(s) - medicine , aortic valve replacement , surgery , ejection fraction , percutaneous , mechanical ventilation , blood loss , cardiology , anesthesia , heart failure , stenosis
Background: Aortic valve replacement (AVR) surgery today offers excellent results with low morbidity and mortality. However, the evolution of surgery encourages us to develop minimally invasive techniques. We report in this study our early experience of AVR by Upper Ministernotomy and describe the surgical technique, learning curve, complications and surgical follow-up.Methods: Between March 2009 and March 2013, 50 patients underwent surgery for AVR at Zagazig university hospitals by inverted T Upper Ministernotomy (mean age 48 ± 11.2). The mean Euro-SCORE was 5.7% ± 4.1 and the ejection fraction was 60% ± 12. Six patients had an associated ascending aortic replacement. The cannulation was performed in femoro-femoral by the direct or percutaneous approach.Results: Mean aortic clamping time for patients with isolated AVR was 91 ± 29 min and bypass time of 123 ± 56 min. One patient required conversion to sternotomy. The mean duration of mechanical ventilation was 10.3 ± 26.3 h, the average length of stay in intensive care units was 2.6 ± 2.2 days, and the mean hospital stay was 9.3 ± 5.8 days. Hospital mortality was 2 patients (4%).Conclusions: The Upper mini-sternotomy for aortic valve surgery is an approach that offers many benefits. However, it is technically more complicated and requires a learning curve beyond which it can offer a lower complication rate with lower pain, blood loss and transfusion, and rapid return to normal activities