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Objective: There are increasing numbers of patients undergoing cardiac surgery through a minimally invasive approach. This study was designed to investigate safety and outcome of patients undergoing minimally invasive aortic surgery compared to the standard median sternotomy technique.
Methods:Between 1994 and 2011 1447 patients underwent aortic surgery at a single heart center. The main indication was replacement of the ascending aorta and aortic arch in combination with repair or replacement of the aortic root and the aortic valve (99,9%). 1277 patients underwent aortic surgery utilizing the standard approach. 170 patients underwent aortic surgery through a limited superior L- or T-type partial sternotomy using minimally invasive cardiac surgery technique (MICS), and determined risk factors for short-term and long-term mortality.
Results: There is no significant difference in survival of the patients with full sternotomy and the MICS approach (p=0.849). Analysis of other outcome-variables such as postoperative infections, cardiac arrhythmia, bleeding, neurological events or low cardiac output syndrome revealed no significant difference. On the average MICS operations lasted 213 compared to 194 minutes (p=0.179) in the standard approach.
Conclusions: MICS can be safely applied in aortic surgery using a partial sternotomy approach without significant differences in mortality and morbidity. The operative trauma is clearly reduced leading to a marked reduction in wound complications. The main indication for full median sternotomy should be in emergency indications.