Ministernotomy: A preliminary experience in heart valve surgery

Abstract

Background/Aim. The last decade of the 20th century brought up a significant development in the field of minimally invasive approaches to the valvular heart surgery. Potential benefits of this method are: good esthetic appearance, reduced pain, reduction of postoperative hemorrhage and incidence of surgical site infection, shorter postoperative intensive care units (ICU) period and overall in-hospital period. Partial upper median sternotomy currently presents as a state-of-the art method for minimally invasive surgery of cardiac valves. The aim of this study was to report on initial experience in application of this surgical method in the surgery of mitral and aortic valves. Methods. The study was designed and conducted in a prospective manner and included all the patients who underwent minimally invasive cardiac valve surgery through the partial upper median sternotomy during the period November 2008 - August 2009. We analyzed the data on mean age of patients, mean extubation time, mean postoperative drainage, mean duration of hospital stay, as well as on occurance of postoperative complications (postoperative bleeding, surgical site infection and cerebrovascular insult). Results. During the observed period, in the Institute for Cardiovascular Diseases of Vojvodina, Clinic for Cardiovascular Surgery, 17 ministernotomies were performed, with 14 aortic valve replacements (82.35%) and 3 mitral valve replacements (17.65%). Mean age of the patients was 60.78 ? 12.99 years (64.71% males, 35.29% females). Mean extubation time was 12.53 ? 8.87 hours with 23.5% of the patients extubated in less than 8 hours. Mean duration of hospital stay was 12.35 ? 10.17 days (in 29.4% of the patients less than 8 days). Mean postoperative drainage was 547.06 ? 335.2 mL. Postoperative complications included: bleeding (5.88%) and cerebrovascular insult (5.88%). One patient (5.88%) required conversion to full sternotomy. Conclusion. Partial upper median sternotomy represents the optimal surgical method for the interventions on the whole ascendant aorta (including aortic valve) and mitral valve through the roof of the left atrium, with a few significant advantages compared to the full sternotomy surgical approach.Uvod/Cilj. Poslednja decenija 20. veka donela je znacajan napredak u razvoju mini invazivnih pristupa u hirurgiji srcanih valvula. Potencijalne prednosti ovih pristupa ukljucuju dobar estetski aspekt, smanjenu bolnost, redukciju krvarenja i mogucnosti infekcije, kraci boravak u jedinici intenzivne nege i kracu hospitalizaciju. Parcijalna gornja sternotomija je trenutno metoda izbora za minimalno invazivnu hirurgiju srcanih valvula. Cilj rada bio je prikaz preliminarnih rezultata pristupa kroz gornju parcijalnu mini-sternotomiju u hirurgiji mitralnih i aortnih valvula. Metode. Ova prospektivna studija obuhvatila je sve bolesnike operisane pristupom kroz parcijalnu gornju sternotomiju u periodu novembar 2008 - avgust 2009. Analizirani su podaci o prosecnoj starosti bolesnika, prosecnom vremenu do ekstubiranja, prosecnom gubitku krvi na dren, prosecnoj duzini hospitalizacije i ucestalosti postoperativnih komplikacija (krvarenje, infekcija operativnog mesta, cerebrovaskularni inzult). Rezultati. U posmatranom periodu u Klinici za kardiovaskularnu hirurgiju Instituta za kardiovaskularne bolesti Vojvodine u Sremskoj Kamenici izvedeno je 17 mini-sternotomija, pri cemu je izvrsena zamena aortne valvule kod 14 bolesnika (82,35%), a mitralne valvule kod 3 bolesnika (17,65%). Prosecna starost bolesnika iznosila je 60,78 ? 12,99 godina (bilo je 64,71% muskaraca i 35,29% zena). Prosecno vreme do ekstubacije iznosilo je 12,53 ? 8,87 casova sa 23,5% bolesnika ekstubiranih za manje od 8 casova. Prosecna duzina hospitalizacije iznosila je 12,35 ? 10,17 dana (kod 29,4% bolesnika manje od 8 dana). Prosecan gubitak krvi na dren iznosio je 547,06 ? 335,2 mL. Postoperativne komplikacije bile su krvarenje (5,88%) i cerebrovaskularni inzult (5,88%). Konverzija u punu sternotomiju ucinjena je kod jednog bolesnika (5,88%). Zakljucak. Parcijalna gornja sredisnja sternotomija omogucuje optimalan hirurski pristup za intervencije na citavoj ascendentnoj aorti (ukljucujuci aortni zalistak) i mitralnom zalisku kroz krov leve pretkomore i ima nekoliko znacajnih prednosti u odnosu na klasican pristup totalnom sternotomijom.