Toporcer Tomáš, Homola Marián, Bereš Anton, Trebišovský Michal, Lopuchovský Tomáš, Mižáková Štefánia, Vajda Lukáš, Lukačín Štefan, Kolesár Adrián
Department of Heart Surgery, East Slovak Institute for Cardiovascular Diseases and Medical Faculty, Pavol Jozef Šafárik University, 04011 Košice, Slovakia.
J Cardiovasc Dev Dis. 2025 Jul 1;12(7):254. doi: 10.3390/jcdd12070254.
In recent decades, aortic valve surgery has transitioned from conventional median sternotomy (MS) to minimally invasive techniques, including partial upper mini-sternotomy (PUMS) and right anterolateral mini-thoracotomy (RAMT). This study retrospectively compares the outcomes of aortic valve replacement (AVR) using PUMS during the learning phase with those of standard MS.
A retrospective analysis was conducted on patients (n = 211) who underwent AVR for aortic stenosis. They were divided into MS (n = 119) and PUMS (n = 92) groups. Various preoperative, surgical and postoperative parameters, including survival, were examined.
Preoperatively, the main difference was age, with PUMS patients being older (67.5 ± 7 vs. 66.5 ± 9.6; = 0.010). PUMS patients also had longer cardiopulmonary bypass (CPB) and cross-clamping times (99 ± 25 vs. 80 ± 16 min; < 0.002; 79 ± 18 vs. 65 ± 13 min; < 0.024). There were no significant differences in body mass index, prosthesis size, indexed effective orifice area, hospitalisation duration or any other monitored parameter. Echocardiographic follow-up found no differences in prosthetic pressure gradients, flow velocity or paravalvular leak between the PUMS and MS groups. Survival rates were similar over 1000 days.
The data suggest that PUMS offers comparable surgical outcomes to MS for AVR with additional cosmetic benefits, undeterred by a learning curve.
近几十年来，主动脉瓣手术已从传统的正中胸骨切开术（MS）转变为微创技术，包括部分上半胸骨切开术（PUMS）和右前外侧小切口开胸术（RAMT）。本研究回顾性比较了学习阶段使用PUMS进行主动脉瓣置换术（AVR）与标准MS的手术结果。
对因主动脉瓣狭窄接受AVR的患者（n = 211）进行回顾性分析。他们被分为MS组（n = 119）和PUMS组（n = 92）。检查了各种术前、手术和术后参数，包括生存率。
术前，主要差异在于年龄，PUMS组患者年龄较大（67.5±7岁 vs. 66.5±9.6岁；P = 0.010）。PUMS组患者的体外循环（CPB）和主动脉阻断时间也更长（99±25分钟 vs. 80±16分钟；P < 0.002；79±18分钟 vs. 65±13分钟；P < 0.024）。体重指数、人工瓣膜尺寸、指数化有效瓣口面积、住院时间或任何其他监测参数均无显著差异。超声心动图随访发现，PUMS组和MS组之间人工瓣膜压力阶差、流速或瓣周漏无差异。1000天以上的生存率相似。
数据表明，对于AVR，PUMS与MS的手术结果相当，且具有额外的美容优势，不受学习曲线的影响。
