Ministernotomy versus conventional sternotomy for aortic valve replacement: matched propensity score analysis of 808 patients†

OBJECTIVES: The proportion of minimally invasive approaches is rising in cardiac surgery, in part driven by increasing patient demand. This study aimed to perform a risk-adjusted comparison of mortality, rate of stroke and perioperative morbidity of aortic valve replace-ment (AVR) conducted through either partial ministernotomy or conventional sternotomy. METHODS: Between July 2009 and July 2012, data from 984 consecutive patients undergoing isolated AVR were prospectively recorded. In 44.3 % (n = 436), the less invasive partial ministernotomy was used. Propensity score matching was performed based on 15 preoperative risk factors to correct for selection bias. In-hospital mortality, stroke rate as well as other major complications in the minimally invasive group and conventional sternotomy group were compared in 404 matched patient pairs (total 808). RESULTS: In-hospital mortality and rate of postoperative intra-aortic balloon pump use were identical for propensity-matched patients, 1.0 % (4 in each group). The rate of stroke [OR (95 % confidence interval (CI)): 0.80 (0.22–2.98)], perioperative myocardial infarction [OR (95 % CI): 2.00 (0.18–22.06)], low-output syndrome [OR (95 % CI): 0.90 (0.37–2.22)], new onset of dialysis [OR (95 % CI): 1.25 (0.49–3.17)] and re-exploration for bleeding [OR (95 % CI): 0.88 (0.50–1.56)] were similar. Likewise, resource utilization (operation time, duration of stay in the intensive care unit and in-hospital stay) and valve selection (type and size) was not affected by the surgical approach either