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Proximal Aortic Surgery: Upper "J" or Conventional Sternotomy?
İsmail Oral Hastaoglu1, Hamdi Tokoz1, Ayca Ozgen2
1Department of Cardiovascular Surgery, Erdem Hospital- Cakmak, Alemdag Caddesi, Istanbul, Turkey.
Insights
Minimally invasive upper "J" hemi-sternotomy for proximal aortic surgery is safe and effective. This approach reduces blood loss, ventilation duration, and hospital stays compared to conventional sternotomy.
Area of Science:
- Cardiac Surgery
- Minimally Invasive Procedures
- Aortic Surgery
Background:
- Minimally invasive cardiac surgery is evolving.
- Experience with minimally invasive proximal aortic surgery is limited.
Purpose of the Study:
- To compare the outcomes of upper "J" hemi-sternotomy with conventional sternotomy for proximal aortic pathology.
Main Methods:
- Retrospective study of 54 patients with upper "J" hemi-sternotomy and 75 with conventional sternotomy (Jan 2010-Mar 2015).
- Matched 45 patients from each group for perioperative comparison.
- Evaluated in-hospital mortality, revision surgery, blood loss, transfusion, cardiopulmonary bypass, aortic cross-clamp and cerebral protection times, ventilation, and hospital stay.
Main Results:
- The upper "J" hemi-sternotomy group showed significantly lower blood loss (P = .026), ventilation duration (P = .001), ICU stay (P = .001), and total hospital stay (P = .004).
- Patient demographics and operative types (ascending aortic replacement, aortic valve replacement, Bentall procedure) were comparable between matched groups.
Conclusions:
- Upper "J" hemi-sternotomy is a safe and effective minimally invasive approach for proximal aortic surgery.
- This technique does not prolong aortic clamp time and leads to reduced blood loss, ventilation, and shorter hospitalizations.
Background:
While minimally invasive procedures are being used in cardiac surgery, experience with minimally invasive proximal aortic surgery has been limited to certain centers.
Methods:
Between January 2010 and March 2015, 54 patients with an upper "J" hemi-sternotomy and 75 patients with a conventional sternotomy due to proximal aortic pathology were included in this study. Forty-five patients from the "J" hemi-sternotomy group were matched with 45 patients from the conventional sternotomy group with respect to age, sex, ejection fraction, diabetes, hypertension, smoking history and operative type. Perioperative variables were in-hospital mortality, surgery for revision, amount of blood loss, requirement for blood transfusion, cardiopulmonary bypass (CPB), aortic cross-clamp and unilateral cerebral protection times, duration of ventilation, and length of intensive care unit (ICU) and total hospital stay.
Results:
Patients were between 21-76 years with a mean age of 58.14 ± 11.06 years; 73.3% (n = 66) were male and 26.7% (n = 24) were female. Of all the cases included, 36.7% (n = 33) had isolated ascending aortic replacement, 41.1% (n = 37) had concomitant aortic valve replacement and ascending aortic replacement, and 22.2% (n = 20) had a Bentall procedure. Statistically, the amount of bleeding (P = .026), length of ventilation (P = .001), ICU (P = .001) and total hospital stay (P = .004) in the "J" hemi-sternotomy group were all found to be significantly lower than those in the conventional group.
Conclusions:
Minimally invasive techniques like an upper "J" hemi-sternotomy can be safely performed without prolonging the aortic clamp time, and with less blood loss, less ventilatory support, and shorter ICU and total hospital stays when compared to conventional methods.