Minimal access aortic surgery including re-operations

Safety and benefits of minimal access ascending aorta and aortic arch surgery, including for re-operations has not been reported.

Fifty-four patients undergoing minimal access operations were evaluated. Of the 54 patients, valve replacements were performed in 76% (41 patients) (including composite valve grafts), and re-operations in 33% (18 patients). Composite valve grafts were used in 28% (15 patients) patients, and elephant trunk type procedures in 6% (three patients).

The survival rate was 96% (52 patients), stroke 3.7% (two patients), and neurocognitive deficit 1.8% (one patient). The circulatory arrest time was 20 min (SD 17), aortic crossclamp time 91 min (SD 45) and cardiopulmonary bypass time 132 min (SD 59). Intraoperative homologous blood transfusion was a mean of 1.3 units (SD 2.3). ICU and postoperative stay were 1.8 days (SD 1.9) and 6.7 days (SD 3.7), respectively. No patient died after re-operation, although one patient had a stroke.

Minimal access aortic surgery does not appear to carry a greater risk and, although more demanding technically, is associated with a reasonable ICU and hospital stay. For re-operations, we particularly recommend the technique.