full sternotomy or minimally invasive

[AZ Don]

My understanding is that the full sternotomy allows full access to the heart and aorta. The mini sternotomy less so, and so requires higher skill and may be higher risk. As other have said, you want the surgeon to be doing the surgery that they are accustomed to. The risks of either procedure are quite low, but they are not zero. While a shorter recovery is desirable, a successful surgery is more important. If I were the OP I would ask about the risks and success rates of the different approaches.

 

[pellicle]

If I were the OP I would ask about the risks and success rates of the different approaches.

I'd go one more, I'd search cardiothoraccic journals for that ...

make sure your Critical Analysis Radar is turned on

https://www.mdpi.com/2077-0383/11/3/547

and on this one abstract only is available for free
https://www.ajconline.org/article/S0002-9149(22)00029-7/abstract

Minimally invasive aortic valve replacement (miAVR) has evolved as an important alternative treatment option to surgical aortic valve replacement (SAVR). The potential advantages include lower periprocedural complications, shorter hospital length of stay (LOS), and patient quality of life with shorter recovery time. Although miAVR has been compared with transcatheter aortic valve replacement (TAVR) previously, the literature is limited to numerous single/multicenter observational studies and meta-analyses of these studies with variable results. This current analysis from a large national database sought to compare the in-hospital outcomes and resource use of miAVR versus those of TAVR and SAVR in the United States.​

I've bolded words that should trigger your critical analysis

• why is it important?
• potential may mean "not for you" and should be asking "for who and what potential advantage"
• why would you even compare a surgical procedure to a "stent like" intervention.

 

[Erwitchin]

full sternotomy or minimally invasive

Hello everyone, I hope you are all well. I am 25 years old and I recently discovered by chance that I have Marfan syndrome. When I consulted with cardiology, it was found that my aortic root is 56mm. I need surgery and I plan to have it in the coming days. I have consulted with 3-4 professors. One of them suggested the mini Bentall procedure, saying that it involves a smaller incision and my recovery would be faster. When I spoke with the others, it seems that my entire chest would need to be opened. Do you have any opinions on this matter? Which option do you think is better for this condition? Have you had any experiences like this? How large was your incision? Can you help me? I'm a bit nervous about surgery. Do you have any recommendations?

My local doctors were all suggesting sternotimy or TAVR as if those were the only options. I don't even qualify for TAVR, since I have a bicuspid aortic valve. I "shopped" around and found a surgeon 4 hours away who specializes in the mini-thoracotomy. I will be having surgery on Wednesday. I don't have time to be unable to use my arms for months while my sternum heals. I specifically chose a more expensive insurance option that would allow me to use doctors out of my state.
As long as you can use a surgeon who is well qualified on the "newer" options, I would not get a full sternotomy. (New since 1996... I have adult kids older than that)

 

[Erwitchin]

The papers...
1st from 2018 finding that minimally invasive procedures are indeed safe and viable

https://www.ncbi.nlm.nih.gov/pmc/ar...dure duration was significantly,group; P<0.01).

this from 2022 comparing recovery and complication rates.

https://link.springer.com/article/10.1007/s12325-022-02263-6