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Minimal access Aortic Valve Surgery with concomitant Aortic procedure: A 9 year experience
Tsuyoshi Kaneko, Gregory Couper, Wernard Borstlap, Foeke Nauta, Laurens Wollersheim, Siobhan McGurk, Lawrence Cohn.
Brigham and Women's Hospital, Boston, MA, USA.
OBJECTIVE: Minimal access approaches through upper hemisternotomy is an established technique for aortic valve surgery (AVS) and aortic surgery in our institution. We assessed the outcome undergoing Aortic valve surgery with concomitant aortic surgery through upper hemisternotomy.
METHODS: We retrospectively reviewed 109 patients from Jan 2002 to May 2011 who had AVS with concomitant aortic surgery through upper hemisternotomy. AVR with supracoronary ascending aortic replacement was performed in 63 patients, AVR with ascending and proximal arch replacement in 7 patients, AVR with aortoplasty in 11 patients, Bentall in 8 patients and AVR with root enlargement in 13 patients. In hospital outcomes and one- and five- year survival were examined.
RESULTS: The mean age was 58.5 years (range 23 - 89y), 40.9% of patients had bicuspid aortic valve (n=45). Ninety patients had true aneurysm (82.6%), 2.8% of patients had calcified aorta (n=3), 8.3% of patients had small annulus (n=9) and 3.7% of patients had calcified annulus (n=4). There were 6 reoperations (5.5%), and 15 (13.8%) urgent cases. Mean perfusion time was 152 +/-61 min, cross clamp time was 108 +/-47 min. Nine cases were performed with deep hypothermic circulatory arrest (8.3%). Operative mortality was 3.7% (n=4). There were 3 cases with reoperation for bleeding (2.7%), 2 strokes (1.8%), 2 new onset renal failure (1.8%). Mean length of stay was 7.1 +/- 5.6 days. Kaplan-Meier analysis showed that 1 year postoperative survival was 96.2% and 5 year survival was 92.4%
CONCLUSIONS: An upper hemisternotomy approach is safe and feasible for AVS and concomitant aortic surgery with excellent early and midterm outcomes. This approach is also associated with low morbidity rate and short length of stay.
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