Outcomes of the Valve-Sparing Root Replacement Procedure with Partial Upper Sternotomy

Area of Science:

• Cardiac Surgery
• Minimally Invasive Techniques
• Aortic Valve Repair

Background:

• Minimally invasive surgery improves patient recovery and quality of life.
• Valve-sparing root replacement (VSRR) is not routinely performed using minimally invasive approaches.
• Experienced centers are increasingly adopting minimally invasive techniques.

Purpose of the Study:

• To evaluate the safety and feasibility of VSRR performed via partial upper sternotomy.
• To compare clinical outcomes between partial upper sternotomy (PUS) and complete sternotomy (CS) for VSRR.

Main Methods:

• Retrospective analysis of 269 VSRR patients (January 2016 - April 2021).
• 52 patients underwent PUS, while the remaining underwent CS.
• Comparison of mortality, aortic insufficiency, blood loss, complications, and hospitalization costs.
• Kaplan-Meier analysis for aortic regurgitation and propensity score matching for sensitivity analysis.

Main Results:

• No significant difference in mortality or moderate/severe aortic insufficiency between PUS and CS groups.
• PUS group showed significantly lower blood loss and blood product consumption (especially plasma).
• Comparable rates of re-exploration, acute kidney injury, and other complications.
• CS group had longer ICU stays and higher hospitalization expenses.
• No deaths or reoperations during follow-up; comparable freedom from aortic insufficiency after matching.

Conclusions:

• Minimally invasive VSRR via partial upper sternotomy is safe and feasible in selected patients.
• Partial upper sternotomy offers advantages in reduced blood loss and shorter ICU stay.
• This technique can be a viable alternative to complete sternotomy for VSRR.