Search

Background: Mini-sternotomy has been proven superior to full sternotomy in aortic valve replacement by providing better perioperative outcomes. We investigated whether such technique provides better outcomes in patients undergoing aortic root surgery., Methods: A comprehensive electronic literature search was undertaken among the four major databases (PubMed, Ovid, Scopus and EMBASE) to identify all published studies up to June 2018. The search terms used related to mini-sternotomy versus full sternotomy, aortic root, valve sparing, Bentall procedure. Only articles that compared mini against full sternotomy were considered in this analysis. After excluding articles based on title or abstract, the full text articles selected had reference lists searched for any potential further articles to be included in this review., Results: A total of 2,765 patients were analysed from across eight comparative studies that were included in the quantitative analysis of the parameters of interest that fulfilled the criteria for meta-analysis. Mini-sternotomy aortic root replacement was associated with significantly shorter cardiopulmonary bypass time (p=0.009), lower rate of blood transfusion (p=0.01). additionally, they had lower operative mortality (p=0.02), and shorter stay at intensive care and at hospital (p=0.0009, p=0.03 respectively). However, there was no difference between mini-sternotomy and conventional aortic root replacement in terms of aortic cross-clamp time (p=0.28), total operation time (p=0.31), re-exploration rate for bleeding (p=0.28), stroke rate (p=0.90), wound infection rate (p=0.96), and length of mechanical ventilation (p=0.10)., Conclusion: Mini-sternotomy is a safe, feasible alternative option to full sternotomy in aortic root repair. However, the significant heterogeneity in data points to the need for a larger, well-designed trial to support the currently limited literature evidences., (Copyright © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Sternal wound infection (SWI) is one of the potential complications post cardiac surgery, and despite refined surgical techniques such as smaller incisions, antibiotic therapy, and optimised glycaemic control, the incidence rate is between <1% in elective cases with low risk factors and as high as 25% in patients with extensive risk factors. The presence of SWI will increase the perioperative morbidity and mortality rates and prolong the patient's hospital stay, therefore the prevention and diagnosis with appropriate management of such adverse outcomes at an early stage is important to prevent further progression as it can be fatal when the mediastinal structures are affected. Currently, the diagnosis typically consists of three main stages: clinical, biochemical including microbiology studies and imaging studies. In the current health care system, the use of computed tomography (CT) and magnetic resonance imaging (MRI) is valuable to define mediastinal abnormalities and can also help find the source of a descending infection. Management is through methods such as antibiotic therapy, surgical debridement, reconstruction with soft tissue flap coverage, sternal plating, and sternectomy. In this literature review, we aim to summarise current literature evidence behind appropriately diagnosing such a catastrophe., (Copyright © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)