Our Summary

This paper is about a study comparing two methods of aortic valve replacement (AVR), a heart surgery. The two methods are full sternotomy (FS), which involves a full incision through the breastbone, and mini-sternotomy (MS), a less invasive method with a smaller incision. The study looked at 756 patients who had AVR surgery between 2014 and 2019. The researchers matched 142 pairs of patients who had either FS or MS, making sure they were similar in other ways.

They looked at various factors during the operation itself, and at death rates and other health problems after the operation. They found that there were no significant differences in the length of the operation, the use of heart-lung bypass, or the time the aorta was clamped between the two groups. The death rates after the operation were also similar between the two groups at 30 days, 1 year, and 5 years. The rates of other health problems after the operation were also similar.

The researchers conclude that there are no significant differences in long-term outcomes between FS and MS for AVR. They suggest that the decision on which method to use should depend on the individual patient’s situation, the surgeon’s experience and comfort level, and the patient’s preference.

FAQs

  1. What are the two methods of aortic valve replacement (AVR) compared in this study?
  2. Did the study find any significant differences in the outcomes between full sternotomy (FS) and mini-sternotomy (MS) for AVR?
  3. What factors should influence the decision on which method to use for AVR according to the study?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sternotomy is to follow post-operative care instructions carefully to ensure proper healing of the incision and to minimize the risk of complications. This may include keeping the incision clean and dry, avoiding activities that strain the chest area, and attending follow-up appointments with the surgeon for monitoring and evaluation. Additionally, the doctor may recommend engaging in gentle exercises to promote healing and prevent stiffness in the chest area.

Suitable For

Patients who are typically recommended sternotomy for AVR surgery include those with severe aortic valve disease, such as aortic stenosis or aortic regurgitation, who have not responded well to other treatments. Patients who have significant symptoms, such as chest pain, shortness of breath, or fatigue, may also be recommended for sternotomy. Additionally, patients who are at high risk for complications with a less invasive approach, such as those with complex anatomy or previous heart surgeries, may be recommended for sternotomy. Ultimately, the decision on whether to perform a full sternotomy or a mini-sternotomy should be made on a case-by-case basis in consultation with a cardiac surgeon.

Timeline

Before sternotomy:

  1. Patient undergoes pre-operative evaluation and tests to determine the need for surgery and the best approach.
  2. Patient discusses the surgery with their healthcare provider and makes a decision on whether to proceed.
  3. Patient is prepared for surgery, including fasting and possibly medications to prevent infection.
  4. Patient is taken to the operating room and general anesthesia is administered.

During sternotomy:

  1. Surgeon makes an incision through the breastbone to access the heart.
  2. The surgery is performed, which may involve repairing or replacing the aortic valve.
  3. The patient is monitored closely during the surgery, including the use of heart-lung bypass if necessary.
  4. The incision is closed and the patient is taken to the recovery room.

After sternotomy:

  1. Patient is closely monitored in the recovery room for any complications.
  2. Patient may experience pain and discomfort at the incision site.
  3. Patient begins the recovery process, including physical therapy and rehabilitation.
  4. Patient is discharged from the hospital and continues to follow up with their healthcare provider for post-operative care and monitoring.
  5. Patient gradually returns to normal activities and lifestyle over time.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a sternotomy procedure?

  2. How does the recovery process differ between full sternotomy and mini-sternotomy?

  3. How long will I need to stay in the hospital after a sternotomy procedure?

  4. Will I need any special follow-up care or rehabilitation after the surgery?

  5. How experienced are you in performing sternotomy procedures, and what is your success rate?

  6. Are there any alternative procedures or treatment options for my condition that do not involve sternotomy?

  7. How will a sternotomy procedure impact my daily activities and quality of life in the long term?

  8. What are the potential long-term effects of a sternotomy procedure on my overall heart health?

  9. Can you provide me with any additional resources or information to help me better understand the risks and benefits of sternotomy for my specific situation?

  10. How often do you recommend follow-up appointments or screenings after a sternotomy procedure?

Reference

Authors: El-Andari R, White A, Fialka NM, Shan S, Manikala VK, Hong Y, Wang S. Journal: J Card Surg. 2022 Dec;37(12):4579-4586. doi: 10.1111/jocs.17158. Epub 2022 Nov 15. PMID: 36378945