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However, whether limited exposure of the heart and ascending aorta resulting from an incision in the second intercostal space may lead to increased intraoperative cerebral embolization and more prominent postoperative neurologic decline, remains inconclusive. The aim of our study was to assess potential neurological complications after two different minimal invasive surgical techniques for aortic valve replacement by measuring cerebral microembolic signal during surgery and by follow-up cognitive evaluation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Trans-cranial Doppler was used for microembolic signal detection during aortic valve replacement performed via mini-sternotomy and mini-thoracotomy. Patients were evaluated using Addenbrooke\u2019s Cognitive Examination Revised Test before and 30\u2009days after surgical procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 60 patients were recruited in the study. In 52 patients, transcranial Doppler was feasible. Of those, 25 underwent mini-sternotomy and 27 had mini-thoracotomy. There were no differences between groups with respect to sex, NYHA class distribution, Euroscore II or aortic valve area. Patients in mini-sternotomy group were younger (60.8\u2009\u00b1\u200914.4 vs.72\u2009\u00b1\u20095.84,<jats:italic>p<\/jats:italic>\u00a0=\u20090.003), heavier (85.2\u2009\u00b1\u200912.4 vs.72.5\u2009\u00b1\u200912.9,<jats:italic>p<\/jats:italic>\u00a0=\u20090.002) and had higher body surface area (1.98\u2009\u00b1\u20090.167 vs. 1.83\u2009\u00b1\u20090.178,<jats:italic>p<\/jats:italic>\u00a0=\u20090.006). Surgery duration was longer in mini-sternotomy group compared to mini-thoracotomy (158\u2009\u00b1\u200924 vs. 134\u2009\u00b1\u00a030\u2009min,<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001, respectively). There were no differences between groups in microembolic load, length of ICU or total hospital stay. Total microembolic signals count was correlated with cardiopulmonary bypass duration (5.64, 95%CI 0.677\u201310.60,<jats:italic>p<\/jats:italic>\u00a0=\u20090.027). Addenbrooke\u2019s Cognitive Examination Revised Test score decreased equivalently in both groups (<jats:italic>p<\/jats:italic>\u00a0=\u20090.630) (MS: 85.2\u2009\u00b1\u20099.6 vs. 82.9\u2009\u00b1\u200911.4,<jats:italic>p<\/jats:italic>\u00a0=\u20090.012; MT: 85.2\u2009\u00b1\u20099.6 vs. 81.3\u2009\u00b1\u20098.8,<jats:italic>p<\/jats:italic>\u00a0=\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There is no difference in microembolic load between the groups. Total intraoperative microembolic signals count was associated with cardiopulmonary bypass duration. Age, but not micorembolic signals load, was associated with postoperative neurologic decline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registry number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/clinicaltrials.gov\">clinicaltrials.gov<\/jats:ext-link>,<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\/ct2\/show\/NCT02697786\">NCT02697786<\/jats:ext-link>14.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s13019-021-01509-8","type":"journal-article","created":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T13:02:56Z","timestamp":1621861376000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Cerebral microemboli in mini-sternotomy compared to mini- thoracotomy for aortic valve replacement: a cross sectional cohort study"],"prefix":"10.1186","volume":"16","author":[{"given":"Marija","family":"Bozhinovska","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matej","family":"Jenko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gordana Taleska","family":"Stupica","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomislav","family":"Kloko\u010dovnik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ju\u0161","family":"K\u0161ela","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matija","family":"Jelenc","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matej","family":"Podbregar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrej","family":"Fabjan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maja","family":"\u0160o\u0161tari\u010d","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,5,24]]},"reference":[{"key":"1509_CR1","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1136\/bmj.330.7495.801","volume":"330","author":"J Chambers","year":"2005","unstructured":"Chambers J. 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Informed consent was obtained in written format.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"142"}}