Minimally Invasive Aortic Surgery With Or Without Aortic Valve Replacement. Single Centre Expericence.
Mariusz Kowalewski1, Jakub Staromlynski1, Radoslaw Smoczynski1, Anna Witkowska1, Wojciech Sarnowski1, Maciej Bartczak1, Leszek Markuszewski2, Marcin Maruszewski1, Piotr Suwalski1.
1Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland, 2Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland.
Background: Minimally invasive aortic valve (AV) surgery has become widely accepted alternative to standard sternotomy approach for the treatment of AV disease. Despite possible reduction in morbidity, this approach is not routinely performed for aortic replacements though. The objective of the current report was to report early surgical data as well as remote outcomes in patients undergoing minimally invasive aortic root- and ascending aorta- replacement with or without concomitant AV replacement (AVR) surgery. Material and methods: Between 2011 and 2018, 167 selected low- and intermediate risk patients (mean age: 64.1±11.3; 70.1% men; EuroSCORE II 2.58±3.26) underwent minimally invasive aortic surgery. Redo-surgeries, endocarditis cases and acute dissections were excluded. The "J" or "V" shaped partial upper sternotomy was performed through a 6-cm skin incision from the notch to the third or fourth intercostal space depending on surgeons' preference. Patients were divided into aortic replacements with and without AVR procedures; demographicsand clinical outcomes were prospectively collected. Kaplan-Meier estimates of survival and freedom from re-intervention have been analyzed as well. Results: Mean follow-up was 3.1 year [Office2] (max 7.7 years). Of 167 patients, 71 (42.5%) underwent aortic surgery with- and 96 (57.5%) without AVR. Average aortic diameter was 5.98±1.44cm. The cardiopulmonary bypass and aortic cross-clamp time was 152.0±46.8 and 101.8±36.8 minutes respectively and were on average longer by 33 and 22 minutes respectively in patients undergoing aortic replacements with AVR. There was one case of conversion to full sternotomy. Median duration of intensive care unit stay was 2.0 [1.0-3.0] days. Thirty-day mortality was 0.6%. Within investigated follow-up, there was one late reoperation due to aortic valve thrombosis; remote survival was estimated at 94.7%. Conclusions: The study proved that aortic surgery with or without aortic valve replacement is feasible and can safely be performed in a minimally invasive fashion involving partial sternotomy in selected patients undergoing aortic surgery.
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