| Abstract [eng] |
This is a retrospective study of patients who underwent isolated aortic valve replacement by means of median sternotomy or ministernotomy. A total of 426 patients aged from 18 to 88 years with isolated aortic valve pathology were examined. 70 patients underwent ministernotomy and 356 patients underwent median sternotomy. All operations were performed between 2011 and 2016 on the base of Vilniaus universiteto ligoninė Santaros klinikos. Data was collected from medical case histories, surgical and anesthesia protocols and outpatient cards. In the first phase of the study, the results of 140 interventions for aortic valve replacement patients were analyzed. In the second stage of the study, the results of 102 interventions performed on the replacement of aortic valve in overweight patients were analyzed. Criterion for inclusion in the study: only isolated pathology of the aortic valve. Exclusion criteria: • Multi-valve damage; • Acquired heart defects requiring correction in conjunction with coronary artery bypass grafting. • Age of patients <18 years. When assessing the gender characteristics of the patients studied, there was a predominance of men – 60.0% of patients after ministernotomy and 54.2% of patients after median sternotomy, the average age of patients who underwent ministernotomy was 60.9 ± 11.4 years; in patients who underwent median sternotomy, it was 63.3 ± 13.2 years (p = 0.155). The characteristics of the operation: An aortic valve replacement using the ministernotomy approach requires the longer aorta clamp duration and increased duration of artificial circulation compared with the median sternotomy group. The length of surgery for patients of both groups is only slightly different. Postoperative characteristics: During stay in an intensive care unit, patients of the ministernotomy group required the statistically significantly shorter duration of artificial lung ventilation, lower dosage of drugs for coagulopathy correction, as well as adrenalin and morphine, and lost less blood oozing through drains. Patients of the ministernotomy group stayed shorter in an intensive care unit compared with patients of the sternotomy group and required transfusion of lower volumes of the red blood mass and fresh-frozen plasma. Ministernotomy shows the statistically better cosmetic result, less pain in the first 7 days after surgery, early rehabilitation, lower rate of hospital mortality and postoperative complications. The length of stay in hospital after the ministernotomy approach was shorter (18 days) compared with the median sternotomy approach (21 days). Patients of the ministernotomy group much more rarely required the prescription of nonsteroidal anti-imflammatory drugs. Upon 30 and 90 days, as well as 2 and 3 years after surgery, there were no significant differences between groups. During the said periods, there were no new cardiac interventions performed. One year after ministernotomy, the number of patients with no complaints was statistically significantly higher. Rate of survival of patients in the ministernotomy group was 91.4%, while in the sternotomy group - 97.1%, however, no significant differences were found out between groups. As a result of correlation analysis, it was found out that a lot more preoperative indices in patients of the sternotomy group linked to the process of surgery and peculiarities of the postoperative period. Those indices include the age, blood coagulability, EuroSCORE, maximum and average gradient, haemoglobin and creatinine levels. In the ministernotomy group, the lower number of factors have impact on results of surgery, that is indirectly proves this approach to be more suitable for the larger category of patients. As a result of analysis of homogenous patients with overweight, it was found out that postoperative indices in patients after ministernotomy were better, namely: a. decreased risk of acute renal failure; b. better subjective sensations in patients after surgery; c. statistically higher number of patients in the ministernotomy group have no complaints upon 90 and 360 days after surgery; d. better cosmetic result; e. less demand in drug therapy for haemodynamic support and less consumption of painkillers. |
