Minimal-access aortic valve replacement with concomitant aortic procedure: a 9-year experience.

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery

Background:

• Upper hemisternotomy is an established minimal-access technique for aortic valve replacement (AVR) and aortic surgery.
• This approach has been utilized in our institution for various cardiac procedures.

Purpose of the Study:

• To assess the outcomes of AVR combined with concomitant aortic surgery performed via an upper hemisternotomy approach.
• To evaluate the safety, feasibility, and efficacy of this surgical technique.

Main Methods:

• Retrospective review of 109 patients undergoing AVR with concomitant aortic surgery through upper hemisternotomy between January 2002 and May 2011.
• Procedures included AVR with ascending aortic replacement, AVR with ascending and proximal arch replacement, AVR with aortoplasty, Bentall procedure, and AVR with root enlargement.
• In-hospital outcomes and 1- and 5-year survival rates were analyzed.

Main Results:

• The study included diverse patient demographics and pathologies, with 41.3% having bicuspid aortic valve and 82.6% presenting with true aneurysm.
• Operative mortality was low at 2.8% (3 patients), with minimal major complications such as reoperation for bleeding (3.7%), myocardial infarction (1.8%), and new-onset renal failure (1.8%).
• Kaplan-Meier survival analysis demonstrated excellent 1-year (96.2%) and 5-year (92.4%) survival rates, with a mean length of stay of 7.1 days.

Conclusions:

• The upper hemisternotomy approach is a safe and feasible option for AVR with concomitant aortic surgery.
• This technique is associated with favorable early and midterm clinical outcomes.
• The approach offers the benefits of low morbidity and a shorter hospital stay.