In a recent study published in the Journal of Cardio-Thoracic Surgery, a team of researchers from Sweden was able to identify an association between aortic valve replacement through a ministernotomy with implantation of a sutureless bioprosthesis and a shorter aortic cross-clamp, cardiopulmonary bypass time and less transfusion of packed red blood cells. However, the researchers found that the procedure was associated with a higher risk for postoperative permanent pacemaker implantation compared with a full sternotomy with a stented bioprosthesis.
Minimally invasive aortic valve replacement (AVR) through a ministernotomy has been developed as an alternative approach to conventional full sternotomy AVR. The technique was developed to reduce surgical trauma and studies have demonstrated favorable postoperative outcomes compared with full sternotomy AVR.
It has been hypothesized that the longer procedural times compared with full sternotomy AVR attenuate the benefits of minimally invasive incisions and ways to shorten procedural time may be of great importance for the success of minimally invasive AVR.
Sutureless aortic bioprostheses are prosthetic valves designed to facilitate implantation, and thus reduce operative and myocardial ischaemia time and previous studies have demonstrated excellent postoperative outcomes and reduced aortic cross-clamp and cardiopulmonary bypass time compared with implantation of conventional stented bioprostheses.
Sutureless bioprostheses may substantially facilitate minimally invasive AVR, and thereby reduce the risks associated with prolonged myocardial ischaemia.
In order to analyze early postoperative outcomes and 2-year survival after AVR performed through a ministernotomy with suture less bioprosthesis implantation compared with a full sternotomy with implantation of a stented bioprosthesis, In the study titled “Aortic valve replacement through full sternotomy with a stented bioprosthesis versus minimally invasive sternotomy with a sutureless bioprosthesis,” Ulrik Sartipy from the Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, in Stockholm, Sweden and colleagues evaluated a group of patients who underwent primary isolated non-emergent AVR. A total of 182 patients underwent a ministernotomy with a sutureless bioprosthesis (ministernotomy sutureless group) and 383 underwent a full sternotomy with a stented bioprosthesis.
Results showed that there were no differences regarding 30-day mortality or 2-year survival between the ministernotomy sutureless group and in the full sternotomy stented group.
The results also showed that aortic cross-clamp and cardiopulmonary bypass time were shorter in the ministernotomy sutureless group. The researchers found that in those patients who underwent ministernotomy, they received less packed red blood cells, however their risk for postoperative permanent pacemaker implantation was higher.