Ministernotomy for aortic valve replacement: A study of the preliminary experience

OBJECTIVE: The aim of the study was to evaluate the technical feasibility a nd the postoperative course of aortic valve replacement through a ministern otomy. SETTING: The Montreal Heart Institute and the Hopital Lariboisiere, Paris, France. DESIGN: A case series from 2 institutions. PATIENTS: Fifty-one patients who underwent aortic valve replacement through a ministernotomy. The sternal incision was started at the level of the ste rnal notch extending down to the third or fourth intercostal space with a t ransverse section of the sternum at this level on both sides or limited to the right side (inverted T or L incision). Thirty-nine patients had aortic stenoses, 6 patients were operated for aortic insufficiency and 6 had mixed disease, The mean land standard deviation) preoperative left ventricular e jection fraction was 0.56 (0.17). MAIN OUTCOME MEASURES: Cardiac bypass time, complications and outcome. RESULTS: The patients received Carbomedics and St. Jude mechanical valves, Hancock and Carpentier-Edwards bioprostheses. Thirty-eight patients were ad ministered antegrade and retrograde cardioplegia, 10 patients antegrade and 3 retrograde blood cardioplegia only. The mean land standard error) cardio pulmonary bypass time and aortic cross-clamp time were 104 (38) minutes and 72 (16) minutes respectively. Two patients (4%) died and 2 patients (4%) s howed evidence of a stroke after the procedure. Hospital stay averaged 8 (5 ) days. CONCLUSION: We conclude that aortic valve replacement can be done through a ministernotomy approach with perioperative results similar to those obtain ed through a conventional sternotomy.