CENTRAL CANNULATION AN ALTERNATIVE TO PERIPHERAL VESSEL CANNULATION FOR AORTIC VALVE REPLACEMENT THROUGH RIGHT THORACOTOMY AND ITS COMPARISON WITH CONVENTIONAL MIDLINE APPROACH

Abstract

Midline sternotomy is consider as conventional approach for aortic valve replacement surgeries. However, sternum disruptions are responsible for increased rate of postoperative bleeding, pain and wound infection leading to longer hospital stay and patient discomfort. Right anterolateral thoracotomy with central cannulation is a minimal invasive approach can be used as an alternative over standard midline sternotomy procedure for aortic valve replacement (AVR) surgeries in developing or underdeveloped countries.
Objective To compare and analyze the intraoperative and postoperative surgical outcomes of patients undergoing aortic valve replacement through right anterolateral thoracotomy by central cannulation with conventional midline sternotomy. To find out utility and cost effectiveness of thoracotomy for aortic valve replacement even in center’s that are not dedicated for minimal invasive cardiac procedures. To find out advantage of limited anterolateral thoracotomy with central cannulation over midline sternotomy and other minimal invasive approaches which requires multiple incision with peripheral cannulation. Methods This is a facility based cross sectional study of 120 patients undergoing aortic valve replacement during the study period of 3 years in a tertiary care hospital. Patients with any co-morbidity or history of any previous surgery (mentioned in the main text) are excluded from the study. Very strict inclusion criteria are used in order to avoid any effect modifications. Based on the surgical approach, the study cohort was divided into right anterolateral thoracotomy group and midline sternotomy group with 60 patients in each respective group. A comparison of intraoperative and postoperative outcome was carried out Results The mean age in the thoracotomy group was 26.03+6.014 years and in the midline sternotomy group was 56.07+10.03 years. The study cohort comprised of 92 (76.7%) males and 28 (23.3%) females. Mean body surface area in thoracotomy group and midline sternotomy group was 1.46+0.16 m2 and 1.62+0.27 m2 respectively. The mean bypass time, aortic cross clamp time and mean operating time in the midline sternotomy group was higher as compared to the thoracotomy group (p<0.05). Duration till mobilization, ICU stay and hospital stay was shorter in thoracotomy group (p=0.000). Wound infection, scar formation and readmission were observed to be higher among patients in the midline sternotomy group than the thoracotomy group (p<0.05).
Conclusion Minimal invasive AVR by single incision such as right anterolateral thoracotomy with central cannulation is an excellent option when compared to conventional midline sternotomy approach. This not only exclude the issues related to midline sternotomy but also avoids multiple incisions and requirement of peripheral cannulation used currently for minimal invasive aortic valve replacement