Our Summary

This paper evaluates two different types of heart valve replacement surgery - one that is minimally invasive (known as ‘mini-AVR’) and a more traditional, invasive surgery (known as ‘AVR’). The researchers looked at data from 5,801 patients who had either of these surgeries between 2011 and 2017.

Their analysis shows that while patients who had the mini-AVR surgery required slightly longer surgery times, they actually had better outcomes than those who had the more invasive AVR procedure. Specifically, fewer people died within 30 days of the mini-AVR surgery, and patients also had a shorter recovery time in hospital. However, more patients that had the mini-AVR surgery required blood transfusions and experienced irregular heartbeats after surgery.

The study concludes that the mini-AVR procedure seems to be a better option, but it also suggests a need for a larger, prospective study to confirm these findings.

FAQs

  1. What are the two types of heart valve replacement surgeries evaluated in this study?
  2. What were the main differences in patient outcomes between the mini-AVR and the traditional AVR procedures?
  3. Does the study conclusively determine that mini-AVR is a better option than AVR?

Doctor’s Tip

A doctor might tell a patient undergoing sternotomy for heart valve replacement surgery that while the minimally invasive approach may have slightly longer surgery times, it often leads to better outcomes with fewer complications and a shorter recovery time in the hospital. It is important to discuss the potential benefits and risks of both options with your doctor before making a decision.

Suitable For

Patients who are recommended sternotomy typically have more complex heart valve conditions that require a more invasive surgical approach. This can include patients with severe valve stenosis or regurgitation, patients with a history of previous heart surgeries, or patients with other underlying health conditions that make them higher risk for surgery. Additionally, patients who require multiple valve replacements or repairs may also be recommended sternotomy.

Timeline

Before sternotomy:

  • Patient undergoes preoperative testing and evaluation to determine the need for surgery
  • Patient is informed about the risks and benefits of the surgery
  • Patient may undergo preoperative preparation such as blood tests, imaging scans, and medication adjustments

After sternotomy:

  • Patient is taken to the operating room and placed under general anesthesia
  • Surgeon makes an incision in the chest and cuts through the sternum to access the heart
  • Heart-lung machine is used to circulate blood while the heart is stopped during surgery
  • Heart valve replacement surgery is performed
  • Sternum is closed with wires and sutures
  • Patient is taken to the intensive care unit for monitoring and recovery
  • Patient undergoes postoperative care including pain management, physical therapy, and monitoring for complications
  • Patient is discharged from the hospital once stable and continues recovery at home with follow-up appointments with their healthcare provider.

What to Ask Your Doctor

Some questions a patient should ask their doctor about sternotomy include:

  1. What are the potential risks and benefits of having a sternotomy for heart valve replacement surgery?
  2. How does the minimally invasive ‘mini-AVR’ surgery compare to the traditional ‘AVR’ surgery in terms of outcomes and recovery time?
  3. What factors will determine whether I am a candidate for the mini-AVR procedure over the AVR procedure?
  4. What is the success rate of the mini-AVR surgery compared to the AVR surgery?
  5. What is the likelihood of needing a blood transfusion or experiencing irregular heartbeats after having a sternotomy?
  6. How long is the typical recovery time for each type of surgery?
  7. Are there any long-term implications or differences in outcomes between the two types of surgery?
  8. What follow-up care or monitoring will be necessary after having a sternotomy for heart valve replacement surgery?
  9. Are there any alternative treatment options to consider besides sternotomy for heart valve replacement?
  10. Are there any ongoing research or clinical trials related to sternotomy procedures that I should be aware of?

Reference

Authors: Paparella D, Malvindi PG, Santarpino G, Moscarelli M, Guida P, Fattouch K, Margari V, Martinelli L, Albertini A, Speziale G. Journal: Eur J Cardiothorac Surg. 2020 Apr 1;57(4):709-716. doi: 10.1093/ejcts/ezz286. PMID: 31647535