Ozgur Mustafa Mert, Hancer Hakan, Gurel Baris, Altas Ozge, Bulut Halil Ibrahim, Bas Tolga, Sarikaya Sabit, Kırali Kaan
Kosuyolu High Specialization Education and Research Hospital, Kartal, IstanbulTurkey. Email:
Kosuyolu High Specialization Education and Research Hospital, Kartal, IstanbulTurkey.
Cardiovasc J Afr. 2025 Jun 30;36(2):196-201. doi: 10.5830/CVJA-2025-022.
Sutureless aortic prostheses are designed to make aortic valve replacement easier than stented or stentless prostheses in patients with significant aortic stenosis. Recently, a more minimally invasive approach combining sutureless aortic valve replacement with small incisions has emerged, but concerns remain about reduced surgical visibility and the risk of permanent pacemaker implantation.
Between 2015 and 2023, 216 patients underwent sutureless aortic valve replacement; of these, only 124 patients who underwent isolated primary aortic valve replacement surgery for severe calcific aortic valve stenosis were included in this study to compare in-hospital outcomes between the upper reversed-T mini-sternotomy and full sternotomy approaches.
The mean age was 73.3 ± 7.1 years for full sternotomy [NK2] and 71.9 ± 5.7 years for mini sternotomy. The differences in preoperative risk factors, including associated cardiac pathologies, left ventricular functions, aortic valve pathologies, and aortic root status, were not significant. The mean aortic cross-clamp and associated total cardiopulmonary bypass times were higher in the mini-sternotomy group without any worsening of perioperative outcomes. Postoperative early complications were similar between the two groups, except for tube drainage and hospital stay, which were worse in the full sternotomy group.
In elderly patients with severe calcific aortic stenosis, sutureless aortic valve replacement via the upper reversed-T mini-sternotomy approach is at least as successful as the full sternotomy method and can be preferred in this patient group due to advantages such as less drainage and faster recovery.
无缝合主动脉瓣膜假体的设计目的是，在患有严重主动脉瓣狭窄的患者中，使主动脉瓣置换术比带支架或无支架假体更容易。最近，一种将无缝合主动脉瓣置换术与小切口相结合的更微创方法已经出现，但对于手术视野减少和永久起搏器植入风险仍存在担忧。
2015年至2023年期间，216例患者接受了无缝合主动脉瓣置换术；其中，本研究仅纳入了124例因严重钙化性主动脉瓣狭窄而接受单纯原发性主动脉瓣置换手术的患者，以比较上倒T形微创胸骨切开术和全胸骨切开术两种方法的院内结局。
全胸骨切开术组的平均年龄为73.3±7.1岁，微创胸骨切开术组为71.9±5.7岁。术前危险因素的差异不显著，包括相关心脏病变、左心室功能、主动脉瓣病变和主动脉根部状况。微创胸骨切开术组的平均主动脉阻断时间和相关体外循环总时间更长，但围手术期结局并未恶化。两组术后早期并发症相似，但全胸骨切开术组的胸腔引流和住院时间更差。
在患有严重钙化性主动脉狭窄的老年患者中，通过上倒T形微创胸骨切开术进行无缝合主动脉瓣置换术至少与全胸骨切开术一样成功，并且由于引流少、恢复快等优点，在该患者群体中可能更受青睐。
