Our Summary

This study compared two types of minimally invasive heart surgeries that are used to replace the aortic valve: the right anterior mini-thoracotomy and the partial upper sternotomy. Researchers looked at 694 surgeries that were performed between 2015 and 2021, and used statistical methods to compare the outcomes for 202 matched pairs of patients.

The results showed that the right anterior mini-thoracotomy had several advantages. It required less time on a heart-lung bypass machine and less time with the heart stopped (cross-clamp time). Patients who had this procedure were able to move around sooner after surgery and had shorter hospital stays. They also had a lower chance of needing a second surgery.

However, there was no difference between the two groups in terms of how many patients died within 30 days or within a year of surgery. After four years, slightly more patients from the right anterior mini-thoracotomy group were still alive.

The researchers concluded that the right anterior mini-thoracotomy should be the first choice for aortic valve replacement when possible. However, the partial upper sternotomy is still a safe option that can be performed by many surgeons.

FAQs

  1. What are the two types of minimally invasive heart surgeries discussed in the study?
  2. What are the advantages of the right anterior mini-thoracotomy procedure?
  3. Was there a difference in the mortality rate between the right anterior mini-thoracotomy and the partial upper sternotomy?

Doctor’s Tip

A doctor might tell a patient undergoing sternotomy for aortic valve replacement that the right anterior mini-thoracotomy is a preferred option due to faster recovery, shorter hospital stays, and a lower chance of needing a second surgery. However, the partial upper sternotomy is still a safe alternative that can be performed by many surgeons. It is important to discuss the options with your doctor to determine the best approach for your individual case.

Suitable For

Patients who are recommended sternotomy for aortic valve replacement typically include those with severe aortic valve disease, such as aortic stenosis or aortic regurgitation. These patients may be experiencing symptoms such as chest pain, shortness of breath, fatigue, or fainting. The decision to recommend sternotomy surgery is based on factors such as the severity of the valve disease, the patient’s overall health, and the risks and benefits of the procedure. Patients who are younger, have fewer comorbidities, and are at lower risk for complications may be good candidates for minimally invasive sternotomy procedures.

Timeline

Before sternotomy, a patient may experience symptoms such as chest pain, shortness of breath, and fatigue due to heart valve disease. They may undergo diagnostic tests such as echocardiograms and cardiac catheterizations to determine the severity of their condition. Once a decision is made to proceed with surgery, the patient will undergo pre-operative preparations such as blood tests, imaging scans, and consultations with the surgical team.

After sternotomy, the patient will be taken to the operating room where they will receive anesthesia. The surgeon will make an incision in the sternum to access the heart and perform the necessary procedure, such as aortic valve replacement. The patient will be placed on a heart-lung bypass machine to support circulation while the heart is stopped. After the surgery is completed, the patient will be transferred to the intensive care unit for monitoring and recovery.

In the days following sternotomy, the patient will gradually regain consciousness and begin physical therapy to aid in recovery. Pain management, wound care, and monitoring of vital signs will be ongoing. The patient will be gradually weaned off of ventilator support and medications as they progress towards discharge from the hospital.

After discharge, the patient will continue to follow up with their healthcare team for monitoring of their heart function and overall recovery. Cardiac rehabilitation may be recommended to help improve physical strength and cardiovascular fitness. Over time, the patient should experience improvement in symptoms and quality of life as they recover from the sternotomy procedure.

What to Ask Your Doctor

  1. What is a sternotomy and why is it sometimes necessary for heart surgeries?
  2. What are the risks and benefits of a sternotomy compared to minimally invasive heart surgeries?
  3. How does a sternotomy affect recovery time and hospital stay compared to other surgical approaches?
  4. Are there specific factors that make a patient a better candidate for a sternotomy versus a minimally invasive approach?
  5. What is the success rate of sternotomy surgeries for aortic valve replacement compared to other techniques?
  6. How experienced is the surgical team with performing sternotomy procedures?
  7. What are the potential complications or long-term effects of a sternotomy surgery?
  8. Are there any alternative treatments or approaches that could be considered instead of a sternotomy?
  9. How should I prepare for a sternotomy surgery, both physically and mentally?
  10. What is the expected outcome and recovery process after a sternotomy surgery for aortic valve replacement?

Reference

Authors: Bakhtiary F, Salamate S, Amer M, Sirat S, Bayram A, Doss M, El-Sayed Ahmad A. Journal: Adv Ther. 2022 Sep;39(9):4266-4284. doi: 10.1007/s12325-022-02263-6. Epub 2022 Jul 29. PMID: 35906515