SpringerLink
Log in

Die superiore Ministernotomie – für welche Operationen?

Upper partial sternotomy —For which procedures?

  • Übersichten
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Hintergrund

Die superiore Ministernotomie oder partielle obere Sternotomie (POS) ist ein minimal-invasiver Zugang zum Herzen, bei dem der Rippenbogen stabil bleibt. Die POS hat sich für den Aortenklappenersatz bereits etabliert; es zeigen sich signifikant bessere Ergebnisse als bei medianer Sternotomie (MS).

Ziel der Arbeit

Diese Publikation gibt einen Überblick darüber, welche Herzoperationen mit Herz-Lungen-Maschine (HLM) über eine POS durchgeführt und welche perioperativen Ergebnisse erzielt werden können.

Material und Methoden

Im Zeitraum von November 2011 bis Juni 2020 wurden an unserer Klinik 1915 Patienten via POS operiert. Die Patienten wurden je nach erfolgter Operation retrospektiv in 8 Gruppen eingeteilt. Prä-, intra- und postoperative Parameter wurden analysiert und mit der Literatur zur MS verglichen.

Ergebnisse

Die Gesamtletalität betrug insgesamt 2,5 %; in den einzelnen Gruppen variierte sie zwischen 0 und 6 %. Die Komplikationsraten hingen von der Art des Eingriffs ab. Im Vergleich zu Literaturdaten der MS wies die POS eine kürzere Beatmungs- und Intensivliegedauer und niedrigere Transfusionsraten auf. Letalität, Inzidenz für Schlaganfälle und Wundheilungsstörungen unterschieden sich nicht, während Nierenversagen etwas häufiger auftrat. Die Operationszeiten waren durchschnittlich um wenige Minuten verlängert.

Fazit

Die POS stellt einen sicheren Zugangsweg für Operationen einzelner oder mehrerer Klappen, der Aorta ascendens, kongenitaler Vitien, Herztumoren, Linksventrikuläres Herzunterstützungssystem(LVAD)-Implantationen und für bestimmte Aorto-Coronarer-Venenbypass(ACVB)-Operationen dar. In Anbetracht dieser Ergebnisse sollte die POS der MS, wenn möglich, vorgezogen werden.

Abstract

Background

Upper partial sternotomy (UPS) is a minimally invasive access to the heart, sparing the lower part of the sternum. The UPS is well established for aortic valve replacement, showing significantly better outcomes than median sternotomy (MS).

Objective

The aim of this study was to evaluate which cardiac procedures with a cardiopulmonary bypass (CPB) can be performed via UPS and which perioperative outcomes can be achieved.

Material and methods

A total of 1915 patients underwent surgery via UPS in this institution between November 2011 and June 2020. The patients were categorized retrospectively into eight groups, depending on the surgery performed. Preoperative, intraoperative and postoperative data were analyzed and compared to the literature data of MS.

Results

The overall in-hospital mortality was 2.5%, ranging from 0% to 6%. The complication rates between the groups varied depending on the type of surgery. In comparison to the literature data of MS, UPS showed shorter ventilation times, shorter ICU stay and lower transfusion rates. Mortality, stroke and wound healing rates were similar, while renal failure occurred slightly more often, and median operation times were a few minutes longer.

Conclusion

The UPS is a safe and feasible approach for surgery of single or multiple valves, the ascending aorta, congenital defects, heart tumors, LVAD implantation and selected bypass surgery. Considering these results, UPS should be preferred over MS when possible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Atik FA, Svensson LG, Blackstone EH et al (2011) Less invasive versus conventional double-valve surgery: a propensity-matched comparison. J Thorac Cardiovasc Surg 141(6):1461–1468.e4

    Article  Google Scholar 

  2. Autschbach R (1998) S‑shaped in comparison to L‑shaped partial sternotomy for less invasive aortic valve replacement. Eur J Cardiothorac Surg 14:117–121

    Article  Google Scholar 

  3. Beckmann A, Meyer R, Lewandowski J et al (2021) German heart surgery report 2020: the annual updated registry of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 69(4):294–307

    Article  Google Scholar 

  4. Beşir Y, Gökalp O, Karaağaç E et al (2019) Mini-thoracotomy versus median sternotomy for atrial septal defect closure: Should mini-thoracotomy be applied as a standard technique? Turk Gogus Kalp Damar Cerrahisi Derg 27(3):280–285

    Article  Google Scholar 

  5. Brown ML, McKellar SH, Sundt TM et al (2009) Ministernotomy versus conventional sternotomy for aortic valve replacement: a systematic review and meta-analysis. J Thorac Cardiovasc Surg 137(3):670–679.e5

    Article  Google Scholar 

  6. Chang C, Raza S, Altarabsheh SE et al (2018) Minimally invasive approaches to surgical aortic valve replacement: a meta-analysis. Ann Thorac Surg 106(6):1881–1889

    Article  Google Scholar 

  7. Cheng DCH, Martin J, Lal A et al (2011) Minimally invasive versus conventional open mitral valve surgery: a meta-analysis and systematic review. Innovations (Phila) 6(2):84–103

    Article  Google Scholar 

  8. Cosgrove DM, Sabik JF (1996) Minimally invasive approach for aortic valve operations. Ann Thorac Surg 62(2):596–597

    Article  Google Scholar 

  9. Deschka H, Erler S, Machner M et al (2013) Surgery of the ascending aorta, root remodelling and aortic arch surgery with circulatory arrest through partial upper sternotomy: results of 50 consecutive cases. Eur J Cardiothorac Surg 43(3):580–584

    Article  Google Scholar 

  10. Guizilini S, Bolzan DW, Faresin SM et al (2010) Ministernotomy in myocardial revascularization preserves postoperative pulmonary function. Arq Bras Cardiol 95(5):587–593

    Article  Google Scholar 

  11. Harky A, Al-Adhami A, Chan JSK et al (2019) Minimally invasive versus conventional aortic root replacement—A systematic review and meta-analysis. Heart Lung Circ 28(12):1841–1851

    Article  Google Scholar 

  12. Kim BS, Soltesz EG, Cohn LH (2006) Minimally invasive approaches to aortic valve surgery: Brigham experience. Semin Thorac Cardiovasc Surg 18(2):148–153

    Article  Google Scholar 

  13. Lee HP, Cho WC, Kim JB et al (2016) Surgical outcomes of cardiac myxoma: right minithoracotomy approach versus median sternotomy approach. Korean J Thorac Cardiovasc Surg 49(5):356–360

    Article  Google Scholar 

  14. Luo W, Chang C, Chen S (2001) Ministernotomy versus full sternotomy in congenital heart defects: a prospective randomized study. Ann Thorac Surg 71(2):473–475

    Article  CAS  Google Scholar 

  15. Mohammed H, Yousuf Salmasi M, Caputo M et al (2020) Comparison of outcomes between minimally invasive and median sternotomy for double and triple valve surgery: a meta-analysis. J Card Surg 35(6):1209–1219

    Article  Google Scholar 

  16. Oezpeker C, Barbieri F, Hoefer D et al (2019) Mitral valve surgery via partial upper sternotomy: closing the gap between conventional sternotomy and right lateral minithoracotomy. Thorac Cardiovasc Surg 67(7):524–530

    Article  Google Scholar 

  17. Phan K, **e A, Di Eusanio M et al (2014) A meta-analysis of minimally invasive versus conventional sternotomy for aortic valve replacement. Ann Thorac Surg 98(4):1499–1511

    Article  Google Scholar 

  18. Rao PN, Kumar AS (1993) Aortic valve replacement through right thoracotomy. Tex Heart Inst J 20(4):307–308

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Rayner TA, Harrison S, Rival P et al (2020) Minimally invasive versus conventional surgery of the ascending aorta and root: a systematic review and meta-analysis. Eur J Cardiothorac Surg 57(1):8–17

    Article  Google Scholar 

  20. Reser D, Holubec T, Scherman J et al (2015) Upper ministernotomy. Multimed Man Cardiothorac Surg. https://doi.org/10.1093/mmcts/mmv036

    Article  PubMed  Google Scholar 

  21. Sakakura R, Asai T, Suzuki T et al (2019) Outcomes after aortic valve replacement for aortic valve stenosis, with or without concomitant coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 67(6):510–517

    Article  Google Scholar 

  22. Schmitto JD, Mariani S, Abicht TO et al (2021) Expert consensus paper: lateral thoracotomy for centrifugal ventricular assist device implant. Ann Thorac Surg 112(5):1687–1697

    Article  Google Scholar 

  23. Svensson LG (1997) Minimal-access „J“ or „j“ sternotomy for valvular, aortic, and coronary operations or reoperations. Ann Thorac Surg 64(5):1501–1503

    Article  CAS  Google Scholar 

  24. Svensson LG, D’Agostino RS (1998) Minimal-access aortic and valvular operations, including the „J/j“ incision. Ann Thorac Surg 66(2):431–435

    Article  CAS  Google Scholar 

  25. Veen KM, Caliskan K, de By TMMH et al (2019) Outcomes after tricuspid valve surgery concomitant with left ventricular assist device implantation in the EUROMACS registry: a propensity score matched analysis. Eur J Cardiothorac Surg 56(6):1081–1089

    Article  Google Scholar 

  26. Wachter K, Franke UFW, Rustenbach CJ et al (2019) Minimally invasive versus conventional LVAD-implantation—An analysis of the literature. Thorac Cardiovasc Surg 67(3):156–163

    Article  Google Scholar 

  27. Welp HA, Herlemann I, Martens S et al (2018) Outcomes of aortic valve replacement via partial upper sternotomy versus conventional aortic valve replacement in obese patients. Interact CardioVasc Thorac Surg 27(4):481–486

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Herzchirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland

    Felix Goldstein, Heinz Deschka, Tomas Kozmik, Sven Martens, Mirela Scherer, Andreas Rukosujew &  Andreas Hoffmeier

Authors
  1. Felix Goldstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heinz Deschka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomas Kozmik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sven Martens
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mirela Scherer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andreas Rukosujew
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andreas Hoffmeier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas Hoffmeier.

Ethics declarations

Interessenkonflikt

F. Goldstein, H. Deschka, T. Kozmik, S. Martens, M. Scherer, A. Rukosujew und A. Hoffmeier geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goldstein, F., Deschka, H., Kozmik, T. et al. Die superiore Ministernotomie – für welche Operationen?. Z Herz- Thorax- Gefäßchir 36, 206–213 (2022). https://doi.org/10.1007/s00398-022-00501-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00398-022-00501-1

Schlüsselwörter

Keywords

Search

Navigation