Minimal invasive cardiac surgery for aortic valve replacement through an upper mini-sternotomy: multicenter experience

Abstract

Background: Aortic valve replacement (AVR) by minimally invasive cardiac surgery (MICS) performed through an upper mini-sternotomy has reduced pain after surgery, the risk of bleeding, and the length of hospital stay.

Patients and methods: From January 2019 until December 2022, 230 patients underwent AVR through a partial upper sternotomy (J or inverted-L). The study assessed our early experience with AVR via ministernotomy, including cannulation, the progression of the learning curve and patient selection, and finally morbidity and mortality.

Results: Early mortality was 1% (2 patients), and morbidities were 4% (4 patients). The average age was 58 ± 9.7. The mean Euro-SCORE was 4.7% ± 3.2 and the ejection fraction (EF) was 40% ± 4.3. The cannulation was performed peripherally in the femoral artery and vein by the direct or percutaneous approach; however, three cases required central cannulation. The average aortic cross clamping time (ACC) for MICS-AVR patients was 83 ± 17 min, and the cardiopulmonary bypass (CPB) time was 114 ± 34 min. The mean duration of mechanical ventilation (MV) was 4.3 ± 2.5 h, the average stay in an intensive care unit (ICU) was 1.4 ± 1.2 days, and the mean hospital stay was 4.3 ± 1.3 days. 30-day mortality was 2 patients (1%). The incidence of blood loss and reopenings for bleeding decreased.

Conclusion: An upper mini-sternotomy can be used safely to replace an aortic valve, and the minimally invasive approach was not associated with increased morbidity or mortality.