Eastern Cardiothoracic Surgical Society

Is Partial Sternotomy a Viable Option in Patients with Concurrent Coronary Artery Disease and Aortic Valve Replacement?
Matthew Thomas, Oleg I. Orlov, Alon Aharon, Arman Saeedi, Sotia Zenios, Konstadinos Plestis, Lankenau Medical Center, Wynnewood, PA

OBJECTIVE: Aortic valve replacement performed via partial sternotomy decreases morbidity and reduces hospital stay. We compared outcomes in patients with asymptomatic CAD who undergone isolated mini-AVR (mAVR-Group) compared to full conventional sternotomy AVR and CABG (CABG-Group).

METHODS: This is a retrospective review of prospectively collected data in 150 patients with concurrent one or two vessel disease, not involving the left main coronary artery who underwent AVR at our institution from January 2006 to June 2016. mAVR-group included 69 patients (mean age 74.1 8.57 years, 69.6% men) and CABG-Group included 94 patients (mean age 72.36 9.66 years, 70.2% men). mAVR-Group had an increased incidence of congestive heart failure [20(29%) vs. 14(14.89%)(p<0.05)] and preoperative PCI[24(34.78%) vs. 14(14.89%)(p<0.05)]. Otherwise, both groups were equivalent with respect to preoperative risk factors.

RESULTS: There was no significant difference in postoperative incidence of stroke [2(2.90%) vs. 2(2.13%)], intraoperative blood transfusion, renal insufficiency [5(7.25%) vs. 4(4.26%)], atrial fibrillation [23(33.33%) vs. 33(35.11%), reoperation for bleeding, ICU stay (5.1 5.77 vs. 5.05 8.16 days), intubation time(1.55 4.46 vs. 1.33 4.74 days), and hospital stay (8.57 6.81 vs. 9.67 9.08 days). Cardiopulmonary bypass and cross-clamp times were shorter for mAVR vs. CABG-groups [(116.01 26.53 vs. 145.19 28.41 and 87.78 18.49 vs. 119.98 22.53 minutes, respectively (p<0.0001)]. Five early deaths occurred in the mAVR-group and none in the CABG-group. No early deaths were attributed to coronary ischemia. Six late mortalities (8.7%) occurred in the mAVR-group and nine (9.6%) in the CABG-group (survival was 98.1% vs. 97.8% one-year, 82.2% vs. 92.2% five-year, 74.0% vs. 81.0% ten-years, mean follow-up 1115 vs.1801 days).

CONCLUSIONS: Minimally-invasive aortic valve replacement with concomitant one or two vessel coronary artery disease can safely be performed without increased incidence of ischemic related complications. Long-term survival is similar to conventional aortic valve CABG.