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J Thorac Cardiovasc Surg 1999;118:991-997
© 1999 Mosby, Inc.

SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE

REOPERATIVE AORTIC VALVE REPLACEMENT: PARTIAL UPPER HEMISTERNOTOMY VERSUS CONVENTIONAL FULL STERNOTOMY

From the Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Mass.

Address for reprints: John G. Byrne, MD, Division of Cardiac Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (E-mail: JGBYRNE{at}BICS.BWH.HARVARD.EDU ).

Objective: We developed techniques for partial upper hemisternotomy for reoperative aortic valve replacement and compared the results with those of reoperative aortic valve replacement by way of conventional full resternotomy.
Methods: We retrospectively analyzed data from 19 patients who underwent conventional full sternotomy and 20 patients who underwent partial hemisternotomy for isolated elective reoperative aortic valve replacements performed between November 1996 and September 1998. Univariable and multivariable analyses were used to document the differences between the groups.
Results: The 2 groups were similar with respect to age, sex, New York Heart Association functional class, valve pathologic characteristics, and numbers and types of previous operations. There were neither any operative deaths nor any postoperative valve-related morbidities in either group. There was 1 injury to a cardiac structure, which occurred in the conventional full sternotomy group. Univariable analysis documented that patients in the conventional full sternotomy group were significantly more likely to have at least 1000 mL blood loss during the first 24 hours after the operation (odds ratio 8.1, P = .02), were more likely to require transfusion of more than 5 units of packed red blood cell (odds ratio 3.6, P = .08), and were more likely to have a total operative duration longer than 5 hours (odds ratio 3.6, P = .08). In the multivariable analysis conventional full resternotomy remained a risk factor for greater blood loss (odds ratio 5.7, P = .06), greater transfusion requirement (odds ratio 2.4, P = .25), and longer total operative duration (odds ratio 7.7, P = .03).
Conclusions: Partial upper hemisternotomy for reoperative aortic valve replacement avoids unnecessary lower mediastinal dissection, thereby reducing blood loss, transfusion needs, and total operative duration. These beneficial effects, which are accomplished without compromising the efficacy of the valve operation, make the partial upper hemisternotomy an excellent alternative to conventional full resternotomy for reoperative aortic valve replacement.

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