Clinical Effect Of Minimally Invasive Upper Sternal Incision And Conventional Median Sternotomy Aortic Valve Replacement

Objective: To evaluate the clinical effect of minimally invasive upper sternal incision and conventional median sternotomy aortic valve replacement.Method: Retrospective analysis the clinical data of 62 patients who underwent aortic valve replacement surgery from Mach 2016 to November 2019.Inclusion criteria:(1)Clinical manifestation,physical examination,TTE,X-ray and CT were used to confirm the diagnosis of simple aortic valve disease;(2)age?75y;(3)NYHA class?III;(4)CAG eliminate coronary heart disease in patient over 50 y and angina pectoris;(5)signed informed consent.exclusion criteria:(1)coexisting aortic root disease and abnormality of ascending aorta;(2)surgical history of chest?lung and heart,chest malformation,scoliosis;(3)pericardium disease and pericardiosymphysis;(4)COPD and sever pulmonary hypertension;(5)active infectious disease;(6)emergency operation.Analysis all data using SPSS20 statistical soft ware.31 patients in minimally invasive upper sternal incision group,25 patients were male,6 patients were female,aged 23-74(57.23±10.21)years.BMI 25.23±3.16.11 patients were simple AR.20 patients were AS and AR.11 patients were rheumatic heart disease;16 patients were senile heart degenerative valvular disease;4 patients were congenital bicuspid aortic valve.14 patients were NYHA class II,17 patients were NYHA class III;LVEDD was 54.52±7.93mm;LVEF 55.81±8.06%;Aortic root diameter was 25.94±2.66mm;AVG of patients with AS was 62.41±17.32 mmHg.31 patients in conventional median sternotomy group,17 patients were male,14 patients were female,aged 30-72(58.09±8.63)years.BMI 24.75±2.96.12 patients were simple AR.19 patients were AS and AR.12 cases were rheumatic heart disease;16 patients were senile heart degenerative valvular disease;3 patients were congenital bicuspid aortic valve.12 patients were NYHA class II,19 patients were NYHA class III;LVEDD was 55.32±12.73mm;LVEF 56.81±8.77%;Aortic root diameter was 25.19±3.62mm;AVG of patients with AS was 63.62±19.33 mmHg.There was no significant difference between the two groups.Result: All patients were treated successfully,no perioperative death,no re-opening thoracic hemostasis.There was no patient transfer to conventional median sternotomy in minimally upper sternal incision group.Compare with conventional group,aortic cross clamp time?cardiopulmonary bypass time and operative time were no significant difference,P>0.05,has no statistically significant difference.ICU stay time?ventilation duration?length of incision?postoperative hospitalization time were shorter,P<0.05,has statistically significant difference;postoperative 24 h amount of drainage?blood transfusion ratio and NRS were decreased,P<0.05,has statistically significant difference.No death case?paravalvular leaks after 3 months of follow-up.The cardiac function has improved.Conclusion:1.Minimally invasive upper sternal incision aortic valve replacement can achieve the same clinical results as conventional median sternotomy and safe.2.Minimally invasive upper sternal incision aortic valve replacement can shorten the length of incision?reduce excudation?time of ICU stay time?ventilation duration?and postoperative hospitalization,alleviate surgical trauma,relieve pain?fast rehabilitation and good cosmetic effect.3.Cardiac surgeon and center with skill of conventional incision experience can easily develop and worthy promote in clinic use.