Aortic valve replacement: J-shaped upper sternotomy versus conventional sternotomy

Kassem, Ehab; Refat, Ali; Salem, Abdmuged; Eldib, Osama Saber

doi:10.21608/zumj.2021.89057.2307

Aortic valve replacement: J-shaped upper sternotomy versus conventional sternotomy

Document Type : Original Article

Authors

¹ CARDIOTHORACIC SURGERY ,FACULTY OF MEDICINE,ZAGAZIG UNIVERSITY ,SHARKIA Egypt

² cardiac surgery , zagazig university hospital

³ cardiothoracic surgery departement at zagazig university hospital, zagazig city, egypt SULTAN QABOOS UNIVERSITY HOSPITAL

⁴ cardiothoracic surgery,faculty of medicine, Zagazig university,Sharkia,Egypt

10.21608/zumj.2021.89057.2307

Abstract

Background: Aortic valve replacement is routinely performed through full sternotomy. Minimal invasive approaches including J-shaped upper sternotomy were introduced to achieve advantages concerning postoperative pain, duration of mechanical ventilation, blood loss and cosmetic state.
Methods: From January 2015 to December 2017, isolated aortic valve replacement was performed through full median sternotomy (group I) in 40 patients (41.2%) and through J-shaped ministernotomy (group II) in 57 patients (58.8%). We retrospectively analyzed the preoperative characteristics, operative and postoperative variables with emphasis on clamping time, bypass time, duration of mechanical ventilation, blood loss, postoperative pain, ICU stay, total hospital stay, morbidity and mortality.
Results: Clamping time and total bypass time were longer in group (II): 64.4 minutes vs. 48.08 minutes and 83.61 minutes vs. 66.97 minutes respectively. Duration of mechanical ventilation was significantly longer in group (I): 10.48 hours vs. 8.04 hours. The amount of blood loss was less in group (II): mean 277.3 mL vs. 464.7 and need for blood transfusion was significantly higher in group (II): 26 (65.0%) vs. 9 (15.8%). Postoperative pain was less in ministernotomy group as reflected by shorter duration of epidural analgesia: 2.79 vs. 6.23 days.
No significant difference was found between the two groups regarding sternal wound infection, re exploration for bleeding or mortality.
Conclusion: J-shaped ministernotomy for aortic valve replacement is a safe technique that has the advantages of less postoperative pain, less blood loss, shorter period of mechanical ventilation and better cosmetic results when compared to conventional full sternotomy.

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