Mini-sternotomy is Better than Complete Sternotomy at the Aortic Valve and the Ascending Aorta Interventions in Patients with Obesity (Propensity-Score-Matching Analysis)
- #AC/VAL 03-EP-2
- Adult Cardiac Surgery/Valves. E-POSTER (ORAL) SESSION 3
- E-Poster (oral)
Mini-sternotomy is Better than Complete Sternotomy at the Aortic Valve and the Ascending Aorta Interventions in Patients with Obesity (Propensity-Score-Matching Analysis)
Ravil M. Muratov, Amirbek S. Midinov, Svetlana I. Babenko, Leo A. Bockeria
A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – D
Abstract
Upper mini-sternotomy has become standard access for the aortic valve and the ascending aorta interventions in some clinics. However, the fear of technical difficulties and the complications development in patients with obesity prevents widespread of this technique.
Material and methods. At the valve surgery department 284 heart valves operations were performed using mini-access in the 2002-2016 years period. 87 operations were performed in patients with obesity (body mass index> 30) (1st group). 73 patients with obesity and performed complete sternotomy were examined as control group (2nd group). The EuroScore risk in the 1st group was 4.7, in the 2nd group -4.02. For an objective comparison of patients groups, a nonparametric method of propensity-score-matching was used in 44 pairs of patients similar in sex, age, BMI, primary or repeated operation, COPD, and diabetes.
Results. hospital mortality was 2% (in the group of complete sternotomy 2.7%). The clamping aortic and CPB time didn’t differ, however, in comparison with the complete sternotomy group blood transfusion (p=0.0001), respiratory insufficiency + duration of mechanical ventilation (p=0.048), deep and superficial wound complications (p=0.006) , narcotic analgesics using(0.0001), exudative pericarditis (p=0.047) were less common. In the comparative analysis of matched groups, mini-access provided a reduction in the erythrocyte mass transfusion need (p = 0.0001), reduced the frequency of minor wound complications (p-0.001), the narcotic analgesics need (p=0.001), and accelerated hospital discharge (p=0.005).
Conclusions. The upper mini- allows to perform full range of primary and repeated interventions on the aortic valve and the ascending aorta in overweight patients. The mini-sternotomy minimizes blood loss, reduces the risk of respiratory failure and wound complications, and accelerates rehabilitation.