eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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1/2022
vol. 19
 
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abstract:
Original paper

Ministernotomy for aortic valve replacement improves early recovery and facilitates proper wound healing – forced propensity score matching design with reference full sternotomy

Marcin Kaczmarczyk
1
,
Jerzy Pacholewicz
1
,
Aleksandra Kaczmarczyk
2
,
Krzysztof Filipiak
3
,
Tomasz Hrapkowicz
1
,
Michał Zembala
4, 5

  1. Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
  2. Department of Neurology, Faculty of Medical Sciences, Medical University of Silesia, University Clinical Center, Katowice, Poland
  3. Department of Cardiac Surgery, Pomeranian Medical University, Independent Public Clinical Hospital no. 2, Szczecin, Poland
  4. Department of Cardiac Surgery, Cardiac and Lung Transplantation Mechanical Circulatory Support, Silesian Center For Heart Diseases, Poland
  5. Pomeranian Medical University, Szczecin, Poland
Kardiochirurgia i Torakochirurgia Polska 2022; 19 (1): 1-10
DOI: https://doi.org/10.5114/kitp.2022.114548
Online publish date: 2022/03/24
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Introduction
With the development of less invasive techniques ministernotomy has become an increasingly popular choice for minimally invasive aortic valve replacement (MIAVR). However, a large discrepancy in the published results, often derived from the center’s own experience, intensifies the need for further re-evaluation in order to better define the real impact of the ministernotomy approach on postoperative clinical condition in short- and long-term observation.

Aim
To assess the safety and efficacy of MIAVR in comparison to a reference full sternotomy AVR (FSAVR).

Material and methods
Between January 2004 and January 2018, 2386 patients underwent isolated surgical aortic valve replacement (AVR) at our institution. 620 patients were treated minimally invasively (MIAVR) and 1766 patients received FSAVR. Forced propensity score 1 : 1 matching and conditional regressive methods were introduced, ensuring valid comparison and correct estimation. Ultimately, 557 well allocated pairs of treated and control patients were included.

Results
In-hospital mortality was low and comparable (1.26% for MIAVR, 1.62% for FSAVR). No significant differences in terms of serious adverse events were found, although in patients undergoing MIAVR there tended to be lower incidence of neurological complications (OR = 0.72; p = 0.09) and low output syndrome (OR = 0.66; p = 0.13). In addition to a much faster extubation and discharge from the ICU as well as improved blood management, MIAVR significantly reduced the risk of wound complications (OR = 0.31; p < 0.0010).

Conclusions
MIAVR is a safe, effective and reproducible procedure providing at least as good results as FSAVR. Nevertheless, it should be especially recommended to obese, diabetic patients with pulmonary and mobility disorders in order to improve their early recovery.

keywords:

minimally invasive, ministernotomy, propensity score
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