Upper hemisternotomy vs. full sternotomy for hemiarch and proximal aortic replacement.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Hemiarch replacement combined with proximal aortic replacement is rarely performed using upper hemisternotomy (UHS).
• This study compares surgical outcomes of UHS versus full sternotomy (FS) for this complex aortic procedure.

Purpose of the Study:

• To evaluate the safety and feasibility of the upper hemisternotomy (UHS) technique for hemiarch and proximal aortic replacement.
• To compare postoperative outcomes between UHS and full sternotomy (FS) approaches.

Main Methods:

• Surgical technique for UHS involving right third or fourth intercostal space incision.
• Establishment of cardiopulmonary bypass (CPB), aortic cross-clamping (ACC), and hypothermic circulatory arrest (HCA) with cerebral perfusion.
• Comparison of operative times (CPB, ACC, HCA) and clinical outcomes between 11 UHS patients and 15 FS patients.

Main Results:

• The UHS group experienced significantly shorter aortic cross-clamping (ACC) times (105 min vs. 157 min, P=0.03).
• No in-hospital deaths were observed in either group.
• Survival rates at 1 and 5 years were comparable between UHS and FS groups (100% and 72.7% vs. 100% and 80%, respectively).

Conclusions:

• Upper hemisternotomy (UHS) is a safe and feasible surgical option for combined hemiarch and proximal aortic replacement.
• The UHS approach demonstrates low morbidity and mortality, comparable to the traditional full sternotomy (FS) method.
• Further research with larger patient cohorts is recommended to validate these findings.