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Minimally invasive versus conventional methods for aortic root surgery: Choosing the right approach

Anastasiia Karadzha1, Ravil Sharifulin1, Sergey Khrushchev2

  • 1E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation.

Asian Cardiovascular & Thoracic Annals
|June 4, 2024
PubMed
Abstract

Insights

Partial upper sternotomy, a minimally invasive approach for aortic root surgery, offers reduced blood loss and comparable outcomes to conventional median sternotomy. This technique is safe and effective for valve-sparing root replacement.

Area of Science:

  • Cardiovascular Surgery
  • Minimally Invasive Surgery
  • Aortic Root Surgery

Background:

  • Partial upper sternotomy is favored for isolated aortic valve replacement due to surgical visibility and cosmetic benefits.
  • Conventional median sternotomy remains the preferred approach for aortic root surgery among most surgeons.
  • This study compares partial sternotomy (PS) with full sternotomy (FS) for aortic root procedures.

Purpose of the Study:

  • To evaluate the safety and effectiveness of a minimally invasive partial upper sternotomy (PS) versus conventional median sternotomy (FS) for aortic root surgery.
  • To compare outcomes including blood loss, transfusion rates, survival, and reoperation rates.

Main Methods:

  • Retrospective analysis of patients undergoing aortic root surgery between 2016 and 2021.
  • Patients were divided into two groups: conventional median sternotomy (FS) and minimally invasive partial sternotomy (PS).
  • Propensity score matching was used, resulting in 156 patients in the FS group and 57 in the PS group.

Main Results:

  • The minimally invasive approach (PS) showed significantly lower blood loss within 24 hours post-surgery (p=0.029) and reduced need for postoperative blood transfusion (p=0.023).
  • Bicuspid aortic valves were more prevalent in the PS group (57.9%) compared to the FS group (40.4%).
  • Survival rates and freedom from reoperation or severe aortic regurgitation after valve-sparing root replacement (David procedure) were comparable between groups at mid-term follow-up (p=0.25; p=0.66).

Conclusions:

  • Minimally invasive partial upper sternotomy is a safe and effective alternative to conventional median sternotomy for aortic root surgery.
  • Partial upper sternotomy offers the advantage of reduced early postoperative blood loss.
  • This approach does not compromise the mid-term results of valve-sparing root replacement.
Keywords:
Minimally invasive approachaortic root surgerypartial upper sternotomy

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