Isolated or Combined Ascending Aortic Replacement through a Partial Sternotomy: Early and Midterm Outcomes

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Surgical Outcomes Research

Background:

• Ascending aortic replacement (AAR) is a critical procedure for aortic diseases.
• Surgical access, specifically partial sternotomy (PS) versus full sternotomy (FS), may influence patient outcomes.
• Investigating the comparative efficacy of different sternotomy approaches in AAR is essential for surgical decision-making.

Purpose of the Study:

• To compare the in-hospital and midterm outcomes of ascending aortic replacement (AAR) using partial sternotomy (PS) versus full sternotomy (FS).
• To evaluate the impact of surgical approach on complication rates, survival, and reoperation.
• To determine if PS approach affects patient recovery and long-term prognosis.

Main Methods:

• Retrospective analysis of 167 patients undergoing elective AAR between 2013 and 2020.
• Patients were divided into PS (n=40) and FS (n=127) groups.
• Propensity score matching (1:3) was employed to minimize confounding factors; in-hospital complications, survival, and reoperation were assessed.

Main Results:

• The PS group experienced longer cross-clamp (94.2 vs. 83 min) and cardiopulmonary bypass times (164.2 vs. 126.8 min).
• Postoperative ventilation time was higher in the PS group, but intensive care unit (ICU) length of stay was unaffected.
• Incidences of bleeding, stroke, mortality, and long-term survival (median follow-up 2 years) were comparable between PS and FS groups.

Conclusions:

• Partial sternotomy for ascending aortic replacement is associated with extended operative times.
• Despite longer procedural durations, the PS approach does not compromise early or long-term patient outcomes.
• Surgical access via partial sternotomy is a viable alternative to full sternotomy for AAR, with similar safety and efficacy profiles.