Partial Upper Sternotomy is a Safe Alternative in Mitral Annulus Decalcification

In patients with major annulus calcifications (MAC) requiring en-bloque decalcification anterolateral minithoracotomy is not suitable for safe and reproducible mitral valve surgery (MVS) procedures. In these cases, full sternotomy (FS) is still the preferred approach. Alternatively, less invasive MVS via partial upper sternotomy (PS) and transseptal access can be used in experienced centers. After reviewing the records of 1741 patients, who were treated with either isolated MVS or combined procedures, we identified 32 patients who had undergone en-bloque decalcification for MAC. The 2 techniques (PS-group n = 17, FS-cohort n = 15) were presented in terms of 1-year mortality as well as intra- and perioperative outcome. In the PS group, the age was 60.06 ± 7.56 patients, 64.7% were female and had a STS Predicted Risk of Mortality (PROM) score of 1.01 ± 1.06. In the FS group the patients (53.3% female) mean age was 58.47 ± 14.45 and had a STS PROM score 2.35 ± 2.73%. Rates of mitral repair were in the PS and FS cohort 64.7% and 46.7%, respectively. One-year mortality for PS-MVS was 5.9% (n = 1) and 20% (n = 3) for FS-MVS. The cardiopulmonary bypass (FS: 181.60 ± 49.99 minutes, PS: 192.83 ± 77.32 minutes and the cross-clamp times (FS: 119.67 ± 46.06, PS: 136.94 ± 54.37 minutes). The observed ventilation times in the PS and FS group were 5 hours (IQR 3.5-9) and 10 hours (IQR 5-15), respectively. A permanent pacemaker implantation was not necessary in any patient. In patients with MAC and en-bloque decalcification PS seems to be a safe access and might be a valid less invasive alternative to minithoracotomy.