Mini-J-sternotomy in aortic valve surgery in elderly patients: results and features

Introduction. Mini-J sternotomy is a minimally invasive alternative to conventional median sternotomy for aortic valve replacement. In elderly patients with a pronounced comorbid background, the safety and reproducibility of this approach remain debatable.

Objective. To evaluate the early outcomes of mini-J-sternotomy for aortic valve replacement in elderly patients (≥ 65 years) compared with younger patients.

Materials and methods. This retrospective single-center study included patients who underwent isolated aortic valve replacement via mini-J sternotomy. Two groups were formed: Group 1 – elderly patients aged 65–75 years, and Group 2 – patients aged 50–60 years. Propensity score matching was applied to ensure group comparability, taking into account demographic and clinical factors. After matching, two balanced cohorts of 20 patients each were obtained. Intraoperative parameters and early postoperative outcomes were assessed.

Results. The mean age was 69,2 ± 3,1 years in Group 1 and 55,6 ± 2,9 years in Group 2. The EuroSCORE II risk was higher in elderly patients (4,1 ± 1,2 % vs. 2,3 ± 0,8 %, p < 0.01). Operative time was 238 ± 27 min in Group 1 and 234 ± 22 min in Group 2 (p = 0,48), cardiopulmonary bypass time was 126 ± 15 and 121 ± 13 min (p = 0,31), and aortic cross-clamp time was 85 ± 9 and 79 ± 11 min (p = 0,12), respectively. Blood loss was 415 ± 95 and 398 ± 88 mL (p = 0,54). There were no conversions of access or in-hospital deaths. Postoperative atrial fibrillation occurred in 4 (20 %) patients in Group 1 and in 3 (15 %) patients in Group 2. Re-exploration for bleeding was required in 1 (5 %) elderly patient. Pneumonia occurred in 1 (5 %) patient in each group, and acute kidney injury in 1 (5 %) patient in Group 1. The duration of mechanical ventilation was 7,4 ± 1,2 h in Group 1 and 7,1 ± 1,3 h in Group 2, ICU stay was 1,5 ± 0,7 and 1,3 ± 0,6 days, and total hospital stay was 13,2 ± 2,1 and 12,7 ± 1,8 days, respectively (p = 0,62). A correlation was found between age and operative time (r = 0,32, p = 0,05), as well as between EuroSCORE II and cardiopulmonary bypass time (r = 0,36, p = 0,03).

Conclusion. Mini-J sternotomy for aortic valve replacement in elderly patients provides early outcomes comparable to those in younger patients and is not associated with an increased rate of complications, longer mechanical ventilation, or prolonged hospitalization, despite a higher preoperative risk.

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