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Updated: May 15, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Minimal-access aortic valve replacement with concomitant aortic procedure: a 9-year experience
Tsuyoshi Kaneko1, Gregory S Couper, Wernard A A Borstlap
1Department of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Insights
Upper hemisternotomy is a safe approach for aortic valve replacement (AVR) and aortic surgery. This minimal-access technique offers good early and midterm outcomes with low morbidity and short hospital stays.
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.
Objective:
Minimal-access approaches through upper hemisternotomy is an established technique for aortic valve replacement (AVR) and aortic surgery in our institution. We assessed the outcome of undergoing AVR with concomitant aortic surgery through upper hemisternotomy.
Methods:
We retrospectively reviewed 109 patients from January 2002 to May 2011 who had AVR with concomitant aortic surgery through upper hemisternotomy. Aortic valve replacement with supracoronary ascending aortic replacement was performed in 65 patients; AVR with ascending and proximal arch replacement, in 8 patients; AVR with aortoplasty, in 11 patients; Bentall procedure, in 8 patients; and AVR with root enlargement, in 13 patients. In-hospital outcomes and 1- and 5-year survival were examined.
Results:
The mean age was 58.5 years (range, 23-89 years); 41.3% of patients had bicuspid aortic valve (n = 45). Of the patients, 82.6% had true aneurysm (n = 90), 2.8% had calcified aorta (n = 3), 8.3% had small annulus (n = 9), and 3.7% had calcified annulus (n = 4). There were 6 (5.5%) reoperations and 15 (13.8%) urgent cases. Mean perfusion time was 152 ± 61 minutes, and cross-clamp time was 108 ± 47 minutes. Nine cases were performed with deep hypothermic circulatory arrest (8.3%). Operative mortality was 2.8% (n = 3). There were 4 (3.7%) cases with reoperation for bleeding, 2 (1.8%) myocardial infarctions, and 2 (1.8%) new-onset renal failure. Mean length of stay was 7.1 ± 5.6 days. Kaplan-Meier analysis showed that 1-year postoperative survival was 96.2% and 5-year survival was 92.4%.
Conclusions:
An upper hemisternotomy approach is safe and feasible for AVR and concomitant aortic surgery with good early and midterm outcomes. This approach is also associated with low morbidity rate and short length of stay.
