Partial versus full sternotomy for aortic valve replacement
Background. Recent trends suggest that smaller incisions reduce postoperative morbidity. This study tests the hypothesis that a partial upper sternotomy improves patient outcome for aortic valve replacement. Methods. A group of 50 patients who underwent aortic valve surgery through a partial upper s...
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| Veröffentlicht in: | The Annals of thoracic surgery 1999-12, Vol.68 (6), p.2209-2213 |
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| container_title | The Annals of thoracic surgery |
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| creator | Szwerc, Michael F Benckart, Daniel H Wiechmann, Robert J Savage, Edward B Szydlowski, Gary W Magovern, George J Magovern, James A |
| description | Background. Recent trends suggest that smaller incisions reduce postoperative morbidity. This study tests the hypothesis that a partial upper sternotomy improves patient outcome for aortic valve replacement.
Methods. A group of 50 patients who underwent aortic valve surgery through a partial upper sternotomy (group I) were compared to 50 patients who underwent aortic valve replacement through a median sternotomy during the same time period (group II). The mean age (60 ± 2 versus 63 ± 2 years; mean ± SEM) and preoperative ejection fractions (53 ± 2 versus 54 ± 2) were similar. Operations were performed with central cannulation, and antegrade/retrograde blood cardioplegia.
Results. There was one death in each group. No differences were found in aortic occlusion time, mediastinal drainage, transfusion incidence, narcotic requirement, length of stay, or cost. The incidence of pleural and pericardial effusions was increased (18.4% versus 3.9%, p < 0.03), and the need for postoperative inotropic support was higher (38.7% versus 19.6%, p < 0.03) in the partial sternotomy group.
Conclusions. Aortic valve replacement can be performed through a partial sternotomy with results comparable to full sternotomy. The partial sternotomy offers a cosmetic benefit, but does not significantly reduce postoperative pain, length of stay, or cost. |
| doi_str_mv | 10.1016/S0003-4975(99)00863-2 |
| format | Article |
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Methods. A group of 50 patients who underwent aortic valve surgery through a partial upper sternotomy (group I) were compared to 50 patients who underwent aortic valve replacement through a median sternotomy during the same time period (group II). The mean age (60 ± 2 versus 63 ± 2 years; mean ± SEM) and preoperative ejection fractions (53 ± 2 versus 54 ± 2) were similar. Operations were performed with central cannulation, and antegrade/retrograde blood cardioplegia.
Results. There was one death in each group. No differences were found in aortic occlusion time, mediastinal drainage, transfusion incidence, narcotic requirement, length of stay, or cost. The incidence of pleural and pericardial effusions was increased (18.4% versus 3.9%, p < 0.03), and the need for postoperative inotropic support was higher (38.7% versus 19.6%, p < 0.03) in the partial sternotomy group.
Conclusions. Aortic valve replacement can be performed through a partial sternotomy with results comparable to full sternotomy. The partial sternotomy offers a cosmetic benefit, but does not significantly reduce postoperative pain, length of stay, or cost.</description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/S0003-4975(99)00863-2</identifier><identifier>PMID: 10617004</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Aortic Valve - surgery ; Female ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Pain, Postoperative ; Postoperative Care ; Postoperative Complications ; Retrospective Studies ; Sternum - surgery</subject><ispartof>The Annals of thoracic surgery, 1999-12, Vol.68 (6), p.2209-2213</ispartof><rights>1999 The Society of Thoracic Surgeons</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c444t-396a7c5042c11ee8cf7ddb2fd52f9b846804865b1a9e659796f4a70f1059483b3</citedby><cites>FETCH-LOGICAL-c444t-396a7c5042c11ee8cf7ddb2fd52f9b846804865b1a9e659796f4a70f1059483b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0003-4975(99)00863-2$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10617004$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Szwerc, Michael F</creatorcontrib><creatorcontrib>Benckart, Daniel H</creatorcontrib><creatorcontrib>Wiechmann, Robert J</creatorcontrib><creatorcontrib>Savage, Edward B</creatorcontrib><creatorcontrib>Szydlowski, Gary W</creatorcontrib><creatorcontrib>Magovern, George J</creatorcontrib><creatorcontrib>Magovern, James A</creatorcontrib><title>Partial versus full sternotomy for aortic valve replacement</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description>Background. Recent trends suggest that smaller incisions reduce postoperative morbidity. This study tests the hypothesis that a partial upper sternotomy improves patient outcome for aortic valve replacement.
Methods. A group of 50 patients who underwent aortic valve surgery through a partial upper sternotomy (group I) were compared to 50 patients who underwent aortic valve replacement through a median sternotomy during the same time period (group II). The mean age (60 ± 2 versus 63 ± 2 years; mean ± SEM) and preoperative ejection fractions (53 ± 2 versus 54 ± 2) were similar. Operations were performed with central cannulation, and antegrade/retrograde blood cardioplegia.
Results. There was one death in each group. No differences were found in aortic occlusion time, mediastinal drainage, transfusion incidence, narcotic requirement, length of stay, or cost. The incidence of pleural and pericardial effusions was increased (18.4% versus 3.9%, p < 0.03), and the need for postoperative inotropic support was higher (38.7% versus 19.6%, p < 0.03) in the partial sternotomy group.
Conclusions. Aortic valve replacement can be performed through a partial sternotomy with results comparable to full sternotomy. The partial sternotomy offers a cosmetic benefit, but does not significantly reduce postoperative pain, length of stay, or cost.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Valve - surgery</subject><subject>Female</subject><subject>Heart Valve Prosthesis Implantation</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Minimally Invasive Surgical Procedures</subject><subject>Pain, Postoperative</subject><subject>Postoperative Care</subject><subject>Postoperative Complications</subject><subject>Retrospective Studies</subject><subject>Sternum - surgery</subject><issn>0003-4975</issn><issn>1552-6259</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1LxDAQhoMo7rr6E5SeRA_VJE3SBg8ii1-woKCeQ5pOoJI2a9IW9t_b3Yp48zQM87wzzIPQKcFXBBNx_YYxzlImc34h5SXGhchSuofmhHOaCsrlPpr_IjN0FOPn2NJxfIhmBAuSY8zm6OZVh67WLhkgxD4mtncuiR2E1ne-2STWh0T7ETHJoN0ASYC10wYaaLtjdGC1i3DyUxfo4-H-ffmUrl4en5d3q9Qwxro0k0LnhmNGDSEAhbF5VZXUVpxaWRZMFJgVgpdESxBc5lJYpnNsCeaSFVmZLdD5tHcd_FcPsVNNHQ04p1vwfVRCZgUluBhBPoEm-BgDWLUOdaPDRhGsttbUzpraKlFSqp01Rcfc2c-Bvmyg-pOaNI3A7QTA-OZQQ1DR1NAaqOoAplOVr_858Q16aXu1</recordid><startdate>19991201</startdate><enddate>19991201</enddate><creator>Szwerc, Michael F</creator><creator>Benckart, Daniel H</creator><creator>Wiechmann, Robert J</creator><creator>Savage, Edward B</creator><creator>Szydlowski, Gary W</creator><creator>Magovern, George J</creator><creator>Magovern, James A</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19991201</creationdate><title>Partial versus full sternotomy for aortic valve replacement</title><author>Szwerc, Michael F ; Benckart, Daniel H ; Wiechmann, Robert J ; Savage, Edward B ; Szydlowski, Gary W ; Magovern, George J ; Magovern, James A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c444t-396a7c5042c11ee8cf7ddb2fd52f9b846804865b1a9e659796f4a70f1059483b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Valve - surgery</topic><topic>Female</topic><topic>Heart Valve Prosthesis Implantation</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Minimally Invasive Surgical Procedures</topic><topic>Pain, Postoperative</topic><topic>Postoperative Care</topic><topic>Postoperative Complications</topic><topic>Retrospective Studies</topic><topic>Sternum - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Szwerc, Michael F</creatorcontrib><creatorcontrib>Benckart, Daniel H</creatorcontrib><creatorcontrib>Wiechmann, Robert J</creatorcontrib><creatorcontrib>Savage, Edward B</creatorcontrib><creatorcontrib>Szydlowski, Gary W</creatorcontrib><creatorcontrib>Magovern, George J</creatorcontrib><creatorcontrib>Magovern, James A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Annals of thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Szwerc, Michael F</au><au>Benckart, Daniel H</au><au>Wiechmann, Robert J</au><au>Savage, Edward B</au><au>Szydlowski, Gary W</au><au>Magovern, George J</au><au>Magovern, James A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Partial versus full sternotomy for aortic valve replacement</atitle><jtitle>The Annals of thoracic surgery</jtitle><addtitle>Ann Thorac Surg</addtitle><date>1999-12-01</date><risdate>1999</risdate><volume>68</volume><issue>6</issue><spage>2209</spage><epage>2213</epage><pages>2209-2213</pages><issn>0003-4975</issn><eissn>1552-6259</eissn><abstract>Background. Recent trends suggest that smaller incisions reduce postoperative morbidity. This study tests the hypothesis that a partial upper sternotomy improves patient outcome for aortic valve replacement.
Methods. A group of 50 patients who underwent aortic valve surgery through a partial upper sternotomy (group I) were compared to 50 patients who underwent aortic valve replacement through a median sternotomy during the same time period (group II). The mean age (60 ± 2 versus 63 ± 2 years; mean ± SEM) and preoperative ejection fractions (53 ± 2 versus 54 ± 2) were similar. Operations were performed with central cannulation, and antegrade/retrograde blood cardioplegia.
Results. There was one death in each group. No differences were found in aortic occlusion time, mediastinal drainage, transfusion incidence, narcotic requirement, length of stay, or cost. The incidence of pleural and pericardial effusions was increased (18.4% versus 3.9%, p < 0.03), and the need for postoperative inotropic support was higher (38.7% versus 19.6%, p < 0.03) in the partial sternotomy group.
Conclusions. Aortic valve replacement can be performed through a partial sternotomy with results comparable to full sternotomy. The partial sternotomy offers a cosmetic benefit, but does not significantly reduce postoperative pain, length of stay, or cost.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>10617004</pmid><doi>10.1016/S0003-4975(99)00863-2</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Aged Aged, 80 and over Aortic Valve - surgery Female Heart Valve Prosthesis Implantation Humans Male Middle Aged Minimally Invasive Surgical Procedures Pain, Postoperative Postoperative Care Postoperative Complications Retrospective Studies Sternum - surgery |
| title | Partial versus full sternotomy for aortic valve replacement |
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