Minimal access aortic root, valve, and complex ascending aortic surgery

We report our entire experience with minimal access aortic root, valve, and complex ascending aortic surgery. A total of 290 consecutive patients underwent aortic root, valve, and ascending aortic surgery between July 1996 and February 2000. Four groups were identified: isolated aortic valve replacement (AV group, n = 227), aortic root replacement (AR group, n = 44), aortic valve replacement with concomitant replacement of the supracoronary ascending aorta (V/A group, n = 9), and isolated ascending aortic replacement (AA group, n = 10). The procedures were performed through a partial upper hemisternotomy (87%) or a right parasternal approach (13%). Overall mortality was 3.1% (n = 7) for the AV group, 2.3% (n = 1) for the AR group, 0% for the V/A group, and 10.0% (n = 1) for the AA group. Complications included reoperation for bleeding in 10 (4.5%), two (4.7%), one (11.1%), and one (11.1%) for the four groups respectively; and sternal wound infection in eight (3.6%) patients of the AV group and one (2.3%) patient of the AR group. Five (2.3%) patients of the AV group suffered stroke. Isolated or more complicated aortic valve, root and ascending aortic surgery is feasible and safe through a minimally invasive approach with acceptable incidence of complications and mortality, without compromising the efficacy of the procedure.