COMPARISON OF EARLY OUTCOME OF AORTIC VALVE REPLACEMENT BETWEEN MINIMALLY INVASIVE CARDIAC SURGERY AND STANDARD MEDIAN STERNOTOMY

Abstract

Background: Minimally invasive cardiac surgery (MICS) for aortic valve replacement (AVR) has gained attention due to its potential advantages over conventional sternotomy, including reduced surgical trauma, faster recovery, and lower complication rates. This study aimed to compare early postoperative outcomes between MICS and sternotomy in a Bangladeshi population. Methods: This comparative prospective cohort study included 30 patients who underwent AVR, with 15 undergoing MICS and 15 undergoing sternotomy at BSMMU, Dhaka, Bangladesh. Baseline characteristics, operative parameters, and early postoperative outcomes were analyzed. Statistical comparisons were performed using appropriate tests, with p < 0.05 considered significant. Results: Baseline characteristics were comparable between groups. MICS had longer operative (180.5 ± 25.3 vs. 160.2 ± 20.1 min, p = 0.04) and cardiopulmonary bypass times (95.1 ± 14.6 vs. 85.7 ± 12.8 min, p = 0.05). However, MICS was associated with shorter ventilation time (6.2 ± 2.4 vs. 10.5 ± 3.1 hours, p = 0.02), ICU stay (48.3 ± 10.7 vs. 72.1 ± 15.2 hours, p = 0.01), and hospital stay (6.4 ± 1.2 vs. 10.2 ± 1.5 days, p < 0.001). MICS patients had lower chest tube drainage (300 ± 85 vs. 450 ± 120 ml, p = 0.003), transfusion rates (20% vs. 53.3%, p = 0.04), and postoperative pain scores (3.1 ± 1.0 vs. 5.2 ± 1.3, p < 0.001). Complication rates, including mortality, bleeding, atrial fibrillation, and acute kidney injury, were similar. Conclusion: MICS for AVR demonstrated superior early recovery outcomes compared to sternotomy, with shorter hospital stays, reduced pain, and lower blood loss, without increasing major complications. These findings support the broader adoption of MICS in appropriate patients.