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Comparison of Minithoracotomy versus Sternotomy in 304 Consecutive Tricuspid Valve Operations.
MedLine Citation:
PMID:  22437268     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: : The relative outcomes of sternotomy versus thoracotomy for tricuspid valve operation were examined over a 22-year period.
METHODS: : Three hundred four consecutive patients undergoing tricuspid valve operation using right minithoracotomy (THORC group; n = 124) versus median sternotomy (STERN group; n = 180) between 1985 and 2007 were retrospectively analyzed. Minithoracotomy used a 6-cm incision with femoral venous cannulation and augmented venous return. Sternotomy patients undergoing aortic valve, coronary bypass, or other procedure not feasible through a right minithoracotomy were excluded.
RESULTS: : Both groups were similar except that STERN patients had an earlier operative year. Combined mitral and tricuspid valve operation was performed in 70% (214/304) of patients. The tricuspid valve was repaired in 59% (180/304) of patients. Previous sternotomy was present in 56% (171/304) of patients. The mean cardiopulmonary bypass times were longer in the THORC group (216 vs. 167 minutes, P < 0.0001). THORC was associated with a lower 30-day mortality (2% vs. 11%, P = 0.007), less atrial fibrillation (18% vs. 34%, P = 0.0025), less renal failure (3% vs. 11%, P = 0.016), and shorter length of stay (11 vs. 15 days, P = 0.012), although these differences were less apparent in more recent years. Stroke (3% vs. 2%, P = 0.72), respiratory failure (7% vs. 31%, P = 0.06), and infection rates (11% vs. 16%, P = 0.25) were similar. Five-year survival was also similar (63% vs. 64%, P = 0.84).
CONCLUSIONS: : Given the limitations of a large, retrospective experience, minithoracotomy versus sternotomy is associated with low short-term morbidity and mortality, with advantages of avoiding sternotomy and minimizing mediastinal dissection in an otherwise high-risk group of patients.
Authors:
Teng C Lee; Bhargavi S Desai; Carmelo Milano; James Jaggers; Donald D Glower
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Innovations (Philadelphia, Pa.)     Volume:  5     ISSN:  1556-9845     ISO Abbreviation:  Innovations (Phila)     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2012-03-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101257528     Medline TA:  Innovations (Phila)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3-6     Citation Subset:  -    
Affiliation:
From the Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC USA.
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