Ministernotomy versus Full Sternotomy Aortic Valve Replacement with a Sutureless Aortic Bioprosthesis: An European Multicenter Registry

Objectives: The aim of this study was to analyze early postoperative outcomes and 2-year survival after aortic valve replacement (AVR) with the sutureless Perceval bioprosthesis performed through ministernotomy compared with full sternotomy.

Methods: A study of 267 consecutive patients who underwent isolated AVR with the sutureless Perceval bioprosthesis between 2010 and 2014 at six European centers. Of these, 189 (70.8%) were performed through ministernotomy and 78 through a full sternotomy. Propensity score matching was used to reduce selection bias.

Results: In the overall cohort, in-hospital mortality was 1.1% and 2.6%, and 2-year survival was 92% and 91% in the ministernotomy group and in the full sternotomy group, respectively. Propensity score matching resulted in 56 pairs with similar characteristics and operative risk. Aortic cross-clamp (44 minute in both groups, p = 0.931) and cardiopulmonary bypass time (69 versus 74 minute, p = 0.363) did not differ between the groups. Apart from higher postoperative peak and mean aortic valve gradients in the ministernotomy group (28.1 versus 23.3 mm Hg, p = 0.026, and 15.2 versus 11.7 mm Hg, p = 0.011), there were no differences regarding early postoperative outcomes in the propensity matched cohort. There were no differences in in-hospital mortality or 2-year survival between the groups.

Conclusion: AVR with the sutureless Perceval bioprosthesis through a ministernotomy is a safe and reproducible procedure that was not associated with prolonged aortic cross-clamp or cardiopulmonary bypass time compared with a full sternotomy. Early postoperative outcomes and 2-year survival were comparable between the two groups.