MINIMALLY INVASIVE AORTIC-VALVE REPLACEMENT THROUGH A TRANSVERSE STERNOTOMY - A WORD OF CAUTION

Objectives-To compare aortic valve replacement (AVR) using a minimally invasive approach through a transverse sternotomy with the establishe d approach of median sternotomy. Design-Retrospective, case-control st udy. Patients-Fourteen high risk patients (median age 78, Parsonnet sc ore of 18%) who underwent AVR performed through a minimally invasive t ransverse sternotomy were compared with a historical group of patients matched for age, sex, and Parsonnet score who underwent AVR performed through a median sternotomy by the same surgeon. Outcome measures-Gro ss clamp time, total bypass time, intensive care stay, postoperative i n-hospital stay, morbidity, and mortality. Results-There were two deat hs in the minimally invasive group and none in the control group (NS). The cross clamp and total bypass times were longer in the minimally i nvasive group (67 and 92 minutes v 46 and 66 minutes, p < 0.001).There was a higher incidence of re-exploration for bleeding (14% v 0%) and paravalvar leaks (21% v 0%) in the minimally invasive group but these differences were not significant. The minimally invasive group had a l onger postoperative in-hospital stay (p = 0.025). The incidence of mor tality or major morbidity was 43% (six of 14) in the minimally invasiv e group and 7% tone of 14) in the matched pairs (p = 0.013). Conclusio ns-AVR can be performed through a transverse sternotomy but the operat ion takes longer and there is an unacceptably high incidence of morbid ity and mortality.