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Published on: December 11, 2017
Minimally invasive aortic root surgery: Midterm results in a 2-year follow-up
Mahmoud Elghannam1, Yazan Aljabery1, Hamid Naraghi1
1Department of Cardiothoracic Surgery, BG University Hospital Bergmannsheil, Ruhr-University of Bochum, Bochum, Germany.
Objectives:
Minimally invasive surgery (MIS) via partial upper sternotomy (PUS) for aortic root surgery represents an alternative to the full median sternotomy (FMS). PUS offers less operative trauma. We analyzed the midterm outcome of root replacement (Bentall) or valve-sparing root replacement (David) via PUS to evaluate the safety of this access.
Methods:
Between November 2011 to April 2017, a total of 47 consecutive patients underwent aortic root surgery with aortic aneurysm and/or localized aortic dissection through Bentall or David operation through PUS mean age (57.9 ± 10.5 years). Bentall operation was performed in 36 patients (77%), whereas 11 patients (23%) received a David procedure. The outcome was carried out in 6-months, 1-year, and 2-years-follow up.
Results:
Mean operation time was 287.3 ± 72.6 minutes, mean cardiopulmonary bypass (CPB) time 174 ± 54.8 minutes, mean cross-clamp time 133 ± 33.1 minutes. Rethoracotomy-rate was (4.2%). Superficial wound healing disturbance was (2%) and no deep sternal infection or sternum instability occurred. Hospitalization-and intensive care unit-stay was 11.8 ± 4.4 and 1.9 ± 1.3 days with a total median ventilation-time of 10 (IQR 7.5-13.5) hours. There was no 30-day-mortality. After 2 years the total rate of mortality, major adverse cardiac and cerebrovascular events, and redo surgery was (6.3%, 4.2%, and 4.2%).
Conclusions:
Minimally invasive aortic root surgery via partial upper sternotomy could be a safe alternative to the full median sternotomy. It requires longer operative times but reduces postoperative morbidity with good postoperative outcome.
Insights
Minimally invasive aortic root surgery using partial upper sternotomy (PUS) is a safe alternative to full median sternotomy (FMS). This approach reduces postoperative morbidity, offering good midterm outcomes despite longer operative times.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Surgery
- Aortic Root Surgery
Background:
- Partial upper sternotomy (PUS) offers a less invasive approach for aortic root surgery compared to full median sternotomy (FMS).
- Evaluating the midterm safety and outcomes of PUS for aortic root procedures is crucial for establishing its clinical utility.
Purpose of the Study:
- To assess the midterm safety and outcomes of minimally invasive aortic root surgery (Bentall or David procedures) performed via PUS.
- To compare the safety profile of PUS against traditional FMS for aortic root replacement.
Main Methods:
- A consecutive series of 47 patients underwent aortic root surgery (Bentall or David) via PUS between November 2011 and April 2017.
- Midterm outcomes were evaluated at 6 months, 1 year, and 2 years post-operation, focusing on safety and clinical events.
Main Results:
- No 30-day mortality was observed. Postoperative complications included a 4.2% rethoracotomy rate and 2% superficial wound healing disturbance.
- Hospitalization and ICU stay were 11.8 and 1.9 days, respectively. Two-year mortality and major adverse events were low (6.3% and 4.2%).
Conclusions:
- Minimally invasive aortic root surgery via PUS is a safe alternative to FMS.
- While operative times are longer, PUS demonstrates reduced postoperative morbidity and favorable midterm outcomes.
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