急性A型大動脈解離に対する低侵襲修復術：厳選された集団における初期経験

The aim of this study was to evaluate the feasibility of minimally invasive repair of type A aortic dissection (MIR-TAAD) using mini sternotomy (MS), which improves early outcomes, and to assess its suitability in a highly selected and hemodynamically stable subset of patients.

All consecutive patients with acute TAAD referred to our department were evaluated for MIR-TAAD if hemodynamically stable and without clinical or CT evidence of coronary ostia involvement. Previous cardiac surgery was an exclusion criterion.

Between 2022 and 2024, 12 of 103 dissections (9 men, mean age 67.7±1.3) underwent MIR-TAAD. Pre-operative GERAADA score was 10.5±2.3%. Five patients had severe aortic regurgitation, and one had hemiparesis. All underwent hemiarch replacement, with four also receiving an Ascyrus Medical Dissection Stent. Three had aortic valve replacement, eight had valve resuspension, and one had root replacement. Average CPB, cross-clamp, and circulatory arrest times were 130.8±35.0, 81.1±32.7, and 26.2±10.2 minutes (mean temperature 27.8±2.0). None received intraoperative transfusions; two required re-exploration for bleeding. Average intubation time was 22.75 [16.88, 47.00] hours, ICU stays 3.50 [2.75, 7.00] days, hospital LOS 8.50 [7.50, 11.75] days, and transfusion usage 0.50 [0.00, 1.50] units (6 patients received no transfusions). There was no 30-day or in-hospital mortality. At the median follow-up of 15.5 months [12.25, 35.50], only one patient died due to non-cardiac-related reasons.

MIR-TAAD can be safely performed by MS in highly selected cases without limiting the range of aortic root or arch procedures. This approach achieved satisfactory short-term outcomes that should be interpreted within this low-risk population context.