Background: Minimally invasive aortic valve surgery (MIAVS) has evolved into a well tolerated, efficient surgical treatment option in experienced centers, providing greater patient satisfaction and lower complication rates. Potential advantages of MIAVR arise from the concept that patient morbidity and potential mortality could be reduced without compromising the excellent results of the conventional procedure which include improved cosmetic results, safer access in the case of reoperation, less postoperative bleeding, lower intensive care unit (ICU) and in-hospital stays, as well as the less incidence of sternal wound
infection. These results were achievable also in high-risk patients and eldery people. Reduced pain and hospital length of stay, decreased time until return to full activity and decreased blood product use have also been demonstrated.
Methods: 120 patients with aortic valve disease randomized into two equal groups; group “A” 60 patients underwent aortic valve surgery through a minimally invasive limited upper sternotomy.
Group “B” 60 patients underwent aortic valve surgery through a full median sternotomy.
Echocardiographic data were performed preoperatively and at the 3rd, 6th month after discharge in all patients.
Standard aortic and right atrial cannulation with cold antegrade crystalloid cardioplegia was adopted in both group“A” and “B”.
Results: There was no statistical difference between the two groups preoperatively regarding their age, sex, NYHA class, EF%, LA spirometric study. There was no operative mortality in both groups but few postoperative complications occurred in both groups. Total hospital stay, ICU stay, postoperative bleeding, inotropic requirement,ventilatory support, blood transfusion was less in group “A”, with better cosmetic
appearance, and more cost effective.
Conclusions: Limited upper sternotomy minimally invasive technique for aortic valve replacement provides excellent exposure of the aortic valve and offers a better cosmetic scar. In addition, minimally invasive limited upper sternotomy is as safe as full median sternotomy for aortic valve surgery, with fewer complications and postoperative pain, less
ICU and hospital stay, fast recovery to work with limited movement restriction after surgery.
It is better to use the limited upper sternotomy incision as an initial approach for aortic valve surgery.