Feasibility and clinical outcome after minimally invasive valve-sparing aortic root replacement

This study aims to examine the feasibility and clinical course after minimally invasive David procedure compared with those via a conventional median sternotomy.

One hundred and ninety-two consecutive patients who underwent elective valve-sparing aortic root replacement (David procedure) with or without additional cusp repair for aortic regurgitation ( n  = 17, 8.9%), dilatation of the aortic root ( n  = 95, 49.5%) or a combination of both pathologies ( n  = 80, 41.7%) were included. Patients with systemic disorders, such as Marfan's syndrome, and emergency cases were excluded. Assessment of quality of life was performed by modified Short Form Health Survey (SF-36) questionnaire. To minimize baseline differences, a matched pair analysis was conducted.

One hundred and seventeen patients (60.9%) received a minimally invasive hemisternotomy (Group 1), 75 patients a conventional median sternotomy (39.1%, Group 2). Patients of Group 1 were significantly younger (56.5 ± 13.6 vs 64.8 ± 11.6, P  < 0.001). Understandably, concomitant cardiac procedures were more frequent in Group 2 ( n  = 7 [6.0%] vs n  = 48 [64.0%], P  < 0.001). In hospital, mortality was 0.9% in Group 1 (1/117) and 2.7% in Group 2 (2/75; P  = 0.562). Blood loss was significantly less in Group 1 (542.6 ± 441.8 vs 996.7 ± 822.6 ml, P  < 0.001). Duration of mechanical ventilation (10.2 ± 21.8 vs 26.9 ± 109.0 h, P  < 0.001) and ICU-stay (1.9 ± 3.6 vs 3.2 ± 5.6 days, P  < 0.001) were significantly shorter in the minimally invasive group, but this differences did not remain after matching. According to SF-36 questionnaire, patients in the minimally invasive group tend to have a higher quality of life.

Minimally invasive valve-sparing aortic root replacement can be done safely via an upper partial sternotomy in experienced hands even if additional cusp repair is required.