Minimal Invasive Concomitant Surgery
Silke Van Genechten1, Pascal Starinieri1, Boris Robic2, Alaaddin Yilmaz1.
1Jessa Hospital, Hasselt, Belgium, 2University Medical Centre Maribor, Maribor, Slovenia.
Background Mini-sternotomy has been proven to be superior to full blown sternotomy in aortic valve replacement by providing better perioperative outcomes. Aortic valve surgery combined with coronary artery bypass surgery is still mainly performed by full sternotomy. Patients, in need of aortic valve replacement accompanied by arterial bypass grafting on the anterior wall, could better be treated via mini sternotomy until the third intercostal space. MethodsProspective collected retrospective data from sixty patients (age: 76.4 ± 10.4) undergoing aortic valve replacement with arterial coronary bypass grafting on the anterior wall was analysed. The mammary artery was harvested thoracoscopically and the procedure was performed via mini-sternotomy combined with the use of minimal invasive extracorporeal circulation (MiECC). ResultsThe procedure was successful in all patients, requiring no conversion to full sternotomy. Mean cross-clamping and cardiopulmonary bypass times were 77.5 ± 21.6 and 109.9 ± 31.7 minutes, respectively. Mean number of distal anastomoses performed was 1.8 ± 0.7. The Length of stay at the hospital was 12.6 ± 7.1 days, respectively. Per-operative blood loss was 694.8 ± 372.6 mL. There were no re-explorations for bleeding. No paravalvular leakage was detected at discharge and no MACCE were registered. ConclusionMini-sternotomy is a safe and feasible technique for patients undergoing concomitant surgery with the advantages of arterial bypass grafting and excellent postoperative courses by avoiding the drawbacks of full sternotomy.
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