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

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.