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J Thorac Cardiovasc Surg 2009;137:670-679
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Ministernotomy versus conventional sternotomy for aortic valve replacement: A systematic review and meta-analysis

Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn

Received for publication January 31, 2008; revisions received June 18, 2008; accepted for publication August 5, 2008.

^_* Address for reprints: Hartzell V. Schaff, MD, 200 1st St SW, Rochester MN 55905. (Email: schaff{at}mayo.edu).

Objective: Most aortic valve replacements are by conventional full median sternotomy. Less invasive approaches have been developed with partial upper sternotomy (ministernotomy).

Methods: Systematic review and meta-analysis were performed with studies comparing ministernotomy and full sternotomy for aortic valve replacement.

Results: Twenty-six studies were selected, with 4586 patients with aortic valve replacement (2054 ministernotomy, 2532 full sternotomy). There was no difference in mortality (odds ratio 0.71, 95% confidence interval 0.49–1.02). Ministernotomy had longer crossclamp and bypass times (weighted mean difference 7.90 minutes, 95% confidence interval 3.50–10.29 minutes, and 11.46 minutes, 95% confidence interval 5.26–17.65 minutes, respectively). Both intensive care unit and hospital stays were shorter with ministernotomy (weighted mean difference –0.46 days, 95% confidence interval –0.72 to –0.20 days, and –0.91 days, 95% confidence interval –1.45 to –0.37 days, respectively). Ministernotomy had shorter ventilation time and less blood loss within 24 hours (weighted mean difference –2.1 hours, 95% confidence interval –2.95 to –1.30 hours, and –79 mL, 95% confidence interval –23 to 136 mL, respectively). Randomized studies tended to demonstrate no difference between ministernotomy and full sternotomy. Rate of conversion from partial to conventional sternotomy was 3.0% (95% confidence interval 1.8%–.4%).

Conclusion: Ministernotomy can be performed safely for aortic valve replacement, without increased risk of death or other major complication; however, few objective advantages have been shown. Surgeons must conduct well-designed, prospective studies of relevant, consistent clinical outcomes to determine the role of ministernotomy in cardiac surgery.

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				M. Scarci, C. Young, and H. Fallouh Is ministernotomy superior to conventional approach for aortic valve replacement? Interactive CardioVascular and Thoracic Surgery, August 1, 2009; 9(2): 314 - 317. [Abstract] [Full Text] [PDF]