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Updated: Nov 5, 2025

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Mini-access open arch repair.

Shi A Kim1, Won Kyung Pyo1, You Jung Ok1

  • 1Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Journal of Thoracic Disease
|May 20, 2021
PubMed
Summary

Minimally invasive open aortic arch repair using hemi-sternotomy is technically feasible and demonstrates excellent early outcomes. This approach offers a safe alternative for complex aortic arch surgeries.

Keywords:
Aortic arch surgeryminimally invasivepartial sternotomy

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Minimally Invasive Surgery

Background:

  • Minimally invasive approaches for open aortic arch repair are underutilized due to perceived high operative risks and technical challenges.
  • Traditional open aortic arch repair often involves extensive sternotomy, leading to longer recovery times and increased morbidity.

Purpose of the Study:

  • To evaluate the technical feasibility and early outcomes of minimally invasive open aortic arch repair.
  • To assess the safety and efficacy of hemi-sternotomy for elective aortic arch replacement.

Main Methods:

  • A consecutive series of 59 patients undergoing elective aortic arch replacement between 2015 and 2020 via upper hemi-sternotomy (n=58) or mini-thoracotomy (n=1).
  • Moderate hypothermic circulatory arrest was employed for all patients; antegrade cerebral perfusion was selectively used for total arch repair.
  • Inverted graft anastomosis was utilized for improved distal aortic anastomosis in confined spaces.

Main Results:

  • Upper hemi-sternotomy involved sternal separation to the second, third, or fourth intercostal spaces in 1.7%, 50.8%, and 45.8% of patients, respectively.
  • The study reported a low mortality rate (1.7%) and a low incidence of major complications, including temporary neurologic deficit (1.7%) and need for mechanical support (1.7%).
  • Procedural times for hemiarch repair were comparable to total arch repair, with a single conversion to full sternotomy (1.7%) due to bleeding.

Conclusions:

  • Minimally invasive open aortic arch repair is technically feasible and associated with excellent early outcomes.
  • Hemi-sternotomy provides a viable and safe alternative for patients requiring aortic arch replacement, challenging previous perceptions of high operative risk.