Skip to content Skip to navigation
University of Warwick
  • Study
  • |
  • Research
  • |
  • Business
  • |
  • Alumni
  • |
  • News
  • |
  • About

University of Warwick
Publications service & WRAP

Highlight your research

  • WRAP
    • Home
    • Search WRAP
    • Browse by Warwick Author
    • Browse WRAP by Year
    • Browse WRAP by Subject
    • Browse WRAP by Department
    • Browse WRAP by Funder
    • Browse Theses by Department
  • Publications Service
    • Home
    • Search Publications Service
    • Browse by Warwick Author
    • Browse Publications service by Year
    • Browse Publications service by Subject
    • Browse Publications service by Department
    • Browse Publications service by Funder
  • Help & Advice
University of Warwick

The Library

  • Login
  • Admin

Mini-sternotomy versus conventional sternotomy for aortic valve replacement : a randomised controlled trial

Tools
- Tools
+ Tools

Hancock, Helen C., Maier, Rebecca H., Kasim, Adetayo, Mason, James, Murphy, Gavin, Goodwin, Andrew, Owens, W. Andrew and Akowuah, Enoch (2021) Mini-sternotomy versus conventional sternotomy for aortic valve replacement : a randomised controlled trial. BMJ Open, 11 (1). e041398. doi:10.1136/bmjopen-2020-041398

[img]
Preview
PDF
WRAP-Mini-sternotomy-versus-conventional-aortic-valve-2021.pdf - Published Version - Requires a PDF viewer.
Available under License Creative Commons Attribution 4.0.

Download (857Kb) | Preview
Official URL: http://dx.doi.org/10.1136/bmjopen-2020-041398

Request Changes to record.

Abstract

Objective To compare clinical and health economic outcomes after manubrium-limited mini-sternotomy (intervention) and conventional median sternotomy (usual care).

Design A single-blind, randomised controlled trial.

Setting Single centre UK National Health Service tertiary hospital.

Participants Adult patients undergoing aortic valve replacement (AVR) surgery.

Interventions Intervention was manubrium-limited mini-sternotomy performed using a 5–7 cm midline incision. Usual care was median sternotomy performed using a midline incision from the sternal notch to the xiphisternum.

Primary and secondary outcome measures The primary outcome was the proportion of patients who received a red cell transfusion postoperatively and within 7 days of index surgery. Secondary outcomes included proportion of patients receiving a non-red cell blood component transfusion and number of units transfused within 7 days and during index hospital stay, quality of life and cost-effectiveness analyses.

Results 270 patients were randomised, received surgery and contributed to the intention to treat analysis. No difference between mini and conventional sternotomy in red-cell transfusion within 7 days was found; 23/135 patients in each arm received a transfusion, OR 1.0 (95% CI 0.5 to 2.0) and risk difference 0.0 (95% CI −0.1 to 0.1). Mini-sternotomy reduced chest drain losses (mean 181.6 mL (SD 138.7) vs conventional, mean 306·9 mL (SD 348.6)); this did not reduce red-cell transfusions. Mean valve size and postoperative valve function were comparable between mini-sternotomy and conventional groups; 23 mm vs 24 mm and 6/134 moderate or severe aortic regurgitation vs 3/130, respectively. Mini-sternotomy resulted in longer bypass (82.7 min (SD 23.5) vs 59.6 min (SD 15.1)) and cross-clamp times (64.1 min (SD 17.1) vs 46·3 min (SD 10.7)). Conventional sternotomy was more cost-effective with only a 5.8% probability of mini-sternotomy being cost-effective at a willingness to pay of £20 000/QALY (Quality Adjusted Life Years).

Conclusions AVR via mini-sternotomy did not reduce red blood cell transfusion within 7 days following surgery when compared with conventional sternotomy

Item Type: Journal Article
Subjects: Q Science > QP Physiology
R Medicine > RD Surgery
Divisions: Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Aortic valve, Aortic valve -- Surgery
Journal or Publication Title: BMJ Open
Publisher: BMJ
ISSN: 2044-6055
Official Date: 29 January 2021
Dates:
DateEvent
29 January 2021Published
7 December 2020Accepted
Volume: 11
Number: 1
Article Number: e041398
DOI: 10.1136/bmjopen-2020-041398
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
PB-PG-1112-29035[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272

Request changes or add full text files to a record

Repository staff actions (login required)

View Item View Item

Downloads

Downloads per month over past year

View more statistics

twitter

Email us: wrap@warwick.ac.uk
Contact Details
About Us