Current Trends in Aortic Root Surgery: The Mini-Bentall Approach

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Minimally Invasive Surgery

Background:

• Mini-sternotomy is increasingly used for aortic valve surgery.
• Safety of mini-sternotomy for aortic root replacement remains under investigation.

Purpose of the Study:

• Compare operative outcomes of mini-Bentall (upper mini-sternotomy) versus full-sternotomy Bentall procedures.
• Evaluate safety and efficacy of the mini-Bentall approach for aortic root replacement.

Main Methods:

• Retrospective comparison of 91 full-sternotomy Bentall and 26 mini-Bentall procedures (Nov 1998-Nov 2016).
• Exclusion of patients with concomitant procedures or deep hypothermic circulatory arrest.
• Outcome variables included operative mortality and major complications.

Main Results:

• No significant differences in preoperative, operative, or postoperative characteristics between groups.
• Mini-Bentall group showed 0% in-hospital mortality and reoperation for bleeding versus 1.1% and 6.6% in the full-sternotomy group.
• No significant differences in transfusion rates, other complications, or stroke; no conversions to median sternotomy.

Conclusions:

• Upper hemisternotomy (mini-Bentall) is a feasible approach for elective aortic root replacement.
• Further prospective studies are needed to establish mini-Bentall as standard of care.