Manubrium-limited sternotomy decreases blood loss after aortic valve replacement surgery

作者：Burdett Clare L; Lage Ignacio Bibiloni; Goodwin Andrew T; White Ralph W; Khan Khalid J; Owens W Andrew; Kendall Simon W H; Ferguson Jonathan I; Dunning Joel; Akowuah Enoch F^*

来源：Interactive Cardiovascular and Thoracic Surgery, 2014, 19(4): 605-610.

DOI：10.1093/icvts/ivu196

• Aortic
• Valve disease
• Minimally invasive surgery

OBJECTIVES: Minimally invasive surgical approaches for aortic valve replacement (AVR) are growing in popularity in an attempt to decrease morbidity from conventional surgery. We have adopted a technique that divides only the manubrium and spares the body of the sternum. We sought to determine whether patients benefit from this less-invasive approach. %26lt;br%26gt;METHODS: We retrospectively analysed our prospectively maintained database to review all isolated aortic valve replacements performed in an 18-month period from November 2011 to April 2013. %26lt;br%26gt;RESULTS: One hundred and ninety-one patients were identified, 98 underwent manubrium-limited sternotomy (Mini-AVR) and 93 had a conventional median sternotomy (AVR). The two groups were well matched for preoperative variables and risk (mean logistic EuroSCORE mini-AVR 7.15 vs AVR 6.55, P = 0.47). Mean cardiopulmonary bypass and aortic cross-clamp times were 10 and 6 min longer, respectively, in the mini-AVR group (mean values 88 vs 78 min, P = 0.00040, and 66 vs 60 min, P = 0.0078, respectively). Mini-AVR patients had significantly less postoperative blood loss, 332 vs 513 ml, P = 0.00021, and were less likely to require blood products (fresh-frozen plasma and platelets), 24 vs 36%, P = 0.042. Postoperative complications and length of stay were similar (discharge on or before Day 4; mini-AVR 15 vs AVR 8%, P = 0.17). Valve outcome (paravalvular leak mini-AVR 2 vs AVR 1%, P = 1.00) and survival (mini-AVR 99 vs AVR 97%, P = 0.36) were equal. %26lt;br%26gt;CONCLUSIONS: A manubrium-limited approach maintains outcomes achieved for aortic valve replacement by conventional sternotomy while significantly reducing postoperative blood loss and transfusion of blood products.

• 出版日期2014-10