The Differences among Full Sternotomy, Partial Sternotomy, and Right Infra-axillary Thoracotomy with Stonehenge Technique for Aortic Valve Surgery

Author(s): Yasushi Tashima, Ryo Fujita, Taichi Sano, Noriyuki Nakamura, Koichi Adachi, Naoyuki Kimura, Atsushi Yamaguchi

Background: The surgical outcomes of trans-right axillary aortic valve replacement (AVR) with Stonehenge technique (SHAVR), which involves in pulling the heart closer to the right chest wall with retraction sutures of the pericardium to improve the surgical view, remains unknown although the partial sternotomy (PAVR) is widely recognized as a minimally invasive approach for AVR. We evaluated the surgical outcomes of the respective approaches compared to the conventional approach (CAVR).

Methods: A retrospective analysis of 137 consecutive patients who underwent isolated and initial AVR was performed at our institution between January 2009 and December 2020. After matching propensity scores with preoperative characteristics, surgical outcomes were compared between the two groups (PAVR vs. CAVR: n = 22 each, SHAVR vs. CAVR: n = 28 each).

Results: The SHAVR group did not show any significant differences in operative time, aortic cross-clamp time, CPB time, postoperative complications, and hospital death compared with the CAVR group. The length of hospital stay was likely to be shorter in the SHAVR group and the PAVR group than in the CAVR group (P = 0.043, P = 0.047). However, in the PAVR group, operative time, aortic cross-clamp time, and CPB time were significantly longer than in the CAVR group (P = 0.029, P = 0.015, P = 0.003), although there were no significant differences in postoperative complications and hospital death. Based on Multivariate risk analysis, PAVR (in comparison to SHAVR) was an independent risk factor for more than 2 hours of prolonged CPB time (P = 0.034).

Conclusion: These findings suggest that SHAVR can be a safe technique and has cosmetic benefits and a faster CPB time than PAVR.