Abstract

BackgroundUse of minimally invasive approaches for isolated aortic valve or ascending aorta surgery is increasing. However, total arch replacement or aortic root repair through a minimally invasive incision is rare. This study was performed to report our initial experience with surgery of the ascending aorta with complex procedures through an upper mini-sternotomy approach.MethodsWe retrospectively analyzed 80 patients who underwent ascending aorta replacement combined with complex procedures including hemi-arch, total arch, and aortic root surgeries from September 2010 to May 2018. Using standard propensity score-matching analysis, 36 patients were matched and divided into 2 groups: the upper mini-sternotomy group (n = 18) and the median sternotomy group (n = 18). The preoperative assessment revealed no statistically significant differences between the two groups.ResultsHospital mortality occurred in one patient (2.8%). The mini-sternotomy group showed a longer cross-clamping time (160 ± 38 vs. 135 ± 36 min, p = 0.048) due to higher rate of valve-sparing aortic root replacement and total arch repair. The cardiopulmonary bypass time in mini-sternotomy group was shorter than that of full sternotomy group (209 ± 47 min vs 218 ± 62 min, p = 0.595) but fell short of significance. There was no significant difference in lower body hypothermia circulatory arrest time between the two groups (40 ± 10 min vs 48 ± 20 min, p = 0.139). The upper mini-sternotomy group displayed a shorter ventilation time (22 vs. 45 h, p = 0.014), intensive care unit stay (4.6 ± 2.7 vs. 7.9 ± 3.7 days, p = 0.005), and hospital stay (8.2 ± 3.8 vs. 21.4 ± 11.9 days, p = 0.001). The upper mini-sternotomy group showed a lower postoperative red blood cell transfusion volume (4.6 ± 3.3 vs. 6.7 ± 5.7 units, p = 0.042) and postoperative drainage volume (764 ± 549 vs. 1255 ± 745 ml, p = 0.034). The rates of dialysis for newly occurring renal failure, neurological complications, and re-exploration were similar between the two groups (p = 1.000).ConclusionThe upper mini-sternotomy approach is safe and beneficial in ascending aorta surgery with complex procedures for aortic dissection, including total arch replacement and aortic root repair.

Highlights

  • Surgical developments have led to faster recovery with a shorter hospital stay, enhanced thoracic stability, reduced pain, and superior cosmetic results

  • The cardiopulmonary bypass (CPB) time was similar between the two groups (209 ± 47 min vs 218 ± 62 min, p = 0.595), but the aortic crossclamping time was longer in the upper mini-sternotomy group than that of full sternotomy group (160 ± 38 vs. 135 ± 36 min, p = 0.048) due to higher rate of valvesparing aortic root replacement and total arch repair

  • The hypothermic circulatory arrest (HCA) time was similar between the two groups(40 ± 10 min vs 48 ± 20 min, p = 0.139), indicating that no more time was spent on descending aorta reconstruction in the upper ministernotomy group than in the control group

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Summary

Introduction

Surgical developments have led to faster recovery with a shorter hospital stay, enhanced thoracic stability, reduced pain, and superior cosmetic results. The use of a minimally invasive approach through an upper mini-sternotomy for isolated aortic valve surgery or combined aortic root and ascending aorta surgery is finding wide consensus and spreading further among cardiac surgery centers worldwide [1,2,3,4]. Ascending aorta surgery with or without combined aortic arch surgery, especially total arch surgery, is not yet widely performed through a minimally invasive surgical incision. The present study was performed to demonstrate that complex aortic surgery including total arch surgery and aortic root repair via a partial upper sternotomy is viable, safe, and equivalent to the standard procedure in terms of both safety and the risk of major adverse cardiac and cerebrovascular events. Total arch replacement or aortic root repair through a minimally invasive incision is rare. This study was performed to report our initial experience with surgery of the ascending aorta with complex procedures through an upper mini-sternotomy approach

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