Our Summary

This research paper is a review of studies that compare two types of heart surgery methods for elderly patients (65 years and older): minimally invasive mitral valve surgery (MIMVS) and conventional sternotomy (CS). The researchers wanted to see which method is safer for older patients.

Their analysis found that patients who had the minimally invasive surgery were less likely to suffer from acute kidney failure and they needed less time on a ventilator. They also needed fewer blood transfusions. Furthermore, their stays in the intensive care unit (ICU) and the hospital overall were shorter.

However, the minimally invasive surgery took longer to perform than the conventional surgery. Specifically, the time taken to stop and restart the heart (cross-clamp time) and the time on a heart-lung machine (bypass time) were longer.

The researchers found no significant difference between the two surgery types in terms of mortality rates, risk of stroke, lung infection, need for reoperation due to bleeding, and irregular heart rhythm after surgery.

In summary, the minimally invasive surgery seems to have some benefits for elderly patients compared to the conventional method, but it takes longer to perform.

FAQs

  1. What are the benefits of minimally invasive mitral valve surgery (MIMVS) over conventional sternotomy (CS) for elderly patients?
  2. Does the length of time it takes to perform minimally invasive surgery affect its safety or effectiveness?
  3. Was there a significant difference in mortality rates, risk of stroke, and other complications between the two types of surgeries?

Doctor’s Tip

A doctor might advise a patient considering sternotomy to discuss the potential benefits and risks of minimally invasive surgery versus conventional sternotomy, taking into account their individual health needs and preferences. They may also recommend maintaining a healthy lifestyle before surgery to improve outcomes and reduce complications. Additionally, following post-operative instructions carefully and attending follow-up appointments are crucial for a successful recovery.

Suitable For

Patients who are recommended sternotomy are typically those who require heart surgery, such as valve repair or replacement, coronary artery bypass grafting, or aortic surgery. These patients may have conditions such as mitral valve disease, aortic valve disease, coronary artery disease, or aortic aneurysm.

In the study mentioned above, elderly patients (65 years and older) were specifically considered for minimally invasive mitral valve surgery (MIMVS) or conventional sternotomy (CS). Patients who are older may benefit from minimally invasive surgery due to reduced risk of complications such as acute kidney failure, shorter ICU and hospital stays, and less need for blood transfusions. However, younger patients may also be recommended sternotomy, depending on their specific condition and overall health.

Ultimately, the decision to recommend sternotomy for a patient will depend on their individual medical history, the specific heart condition they have, and their overall health and risk factors. A cardiac surgeon will evaluate each patient’s case and determine the most appropriate surgical approach for them.

Timeline

Before sternotomy:

  • Patient undergoes preoperative evaluations including medical history, physical examination, and imaging tests
  • Patient may undergo a cardiac catheterization to assess the severity of the heart condition
  • Patient may receive preoperative instructions on medications and diet
  • Patient may meet with the surgical team to discuss the procedure and potential risks

After sternotomy:

  • Patient is taken to the operating room and given anesthesia
  • Surgeon makes an incision in the chest and separates the breastbone (sternum)
  • Surgeon performs the necessary heart surgery procedure (e.g. mitral valve repair or replacement)
  • Surgeon closes the incision with sutures or staples
  • Patient is taken to the intensive care unit (ICU) for monitoring and recovery
  • Patient may need to stay in the hospital for several days to weeks depending on the surgery and recovery progress
  • Patient undergoes postoperative follow-up appointments to monitor healing and recovery progress

What to Ask Your Doctor

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

  1. What are the potential risks and complications associated with sternotomy surgery?
  2. How does sternotomy compare to minimally invasive surgery in terms of recovery time and post-operative care?
  3. Will I need blood transfusions during or after the surgery, and if so, what are the risks associated with this?
  4. How long can I expect to stay in the ICU and hospital after a sternotomy surgery?
  5. What is the likelihood of experiencing acute kidney failure or other complications after a sternotomy surgery?
  6. How experienced is the surgical team in performing sternotomy procedures?
  7. What are the long-term outcomes and success rates for patients who undergo sternotomy surgery?
  8. Are there any alternative treatment options to sternotomy that I should consider?
  9. How will my age and overall health impact the success and safety of a sternotomy surgery?
  10. Can you explain the specific steps involved in the sternotomy procedure, including the use of a heart-lung machine and cross-clamp time?

Reference

Authors: Hage A, Hage F, Al-Amodi H, Gupta S, Papatheodorou SI, Hawkins R, Ailawadi G, Mittleman MA, Chu MWA. Journal: Innovations (Phila). 2021 Jul-Aug;16(4):310-316. doi: 10.1177/15569845211000332. Epub 2021 Mar 30. PMID: 33781118