Partial Sternotomy for AVR in Obese Patients, Could It Improve the Outcome?

Background: Despite recent disputes over the obesity paradox among open heart surgery patients, obesity continues to have a negative impact on their outcomes, particularly while managing sternotomy wounds. Aim of study: This study investigated the potential clinical value of minimalizing the sternotomy incision in obese patients (Body mass index (BMI) > 30 kg/m2) undergoing aortic valve replacement (AVR). Patients and methods: This study included a total of 208 patients who underwent elective AVR at Cairo and Beniseuf University Hospitals during the period from January 2022 to February 2025. Depending on the sternotomy technique, the patients were divided into two groups; Group A (the FS-AVR group; full sternotomy group) included 108 patients, and Group B (mini-AVR; mini-sternotomy group)) included 100 patients. Retrospective data collection and analysis were conducted for preoperative, intraoperative, and postoperative parameters. Results: There was no in-hospital mortality in either group. The total Operative (3.5 ± 1.35 vs. 3.3± 0.85), cardiopulmonary bypass (CPB (1.8 ± 0.7 vs.1.6 ± 0.9), and aortic cross clamp (ACC (2.1 ± 0.7 vs. 1.9 + 0.9) times were not significantly higher in the mini-AVR group. The mini-AVR group had significantly lower rates of postoperative prolonged mechanical ventilation (MV (3 (3%) vs. 11 (10.19%)) time, ICU stay (5 (5%) vs.18 (13.89%)), and hospital stay (5 (5%) vs. 19 (17.59%)). The mini-AVR group had considerably less chest reopening for high mediastinal drainage (1 (1%) vs. 7 (6.48%)) and PRBC’s transfusions 48 hours after surgery (1.82 ± 0.96 vs. 2.25 ± 1.67). The FS-AVR group had significantly higher rates of sternal wound infection (1 (1%) vs. 7 (6.48%)). No recorded early deaths among both groups. Conclusion: besides providing safe and effective alternative to the conventional full sternotomy in obese patients undergoing isolated AVR, partial upper sternotomy improvs the outcome regarding postoperative early mortality and morbidity.