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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.
The Heart Surgery Forum
|February 28, 2018
Summary
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.