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David I Reimplantation Procedure And Bentall-De Bono Operation Through Partial Upper J Ministernotomy: A Safe Option.
Mauro Del Giglio1, Elisa Mikus2, Simone Calvi2.
1Villa Torri Hospital, Bologna, Italy, 2Maria Cecilia Hospital, Cotignola, Italy.

OBJECTIVE: Combined surgery of both the aortic valve and the ascending aorta through an upper “J” sternotomy approach has not been widely described in literature. We describe our experience using a minimally invasive approach for aortic valve (AV) and ascending aorta replacement using either David I (reimplantation) or Bentall technique
METHODS: T4 patients who received both an ascending aorta and aortic valve replacement at our institution between January 2009 and September 2012 were retrospectively reviewed. 16 of them underwent an aortic valve-sparing surgery and the other 18 a Bentall operation. There were 29 male (85,3%) and the mean age was 57.6±12.1 years (range: 35-79 years). Median aortic root diameter was 54.3 mm. In case of AV-sparing procedure the ascending aorta has been replaced with a Vascutek Terumo Gelweave Valsalva graft up to the origin of the brachio-cefalic artery
RESULTS: The hospital mortality was 2/34 (5.8%) Median cardiopulmonary bypass time and mean cross-clamp time were respectively 136.3 ±48.7 min and 118.9±39.4 min. Median intensive care unit stay was 2.4 days and total length-of-stay was 10.2 days. Two patients needed to be revisited for mediastinal bleeding. There was no sternal or wound complications
CONCLUSIONS: A partial upper sternotomy is considered a safe option for aortic valve replacement. Our experience confirms that a partial upper “J”-shaped sternotomy can be chosen also for complex aortic root surgery like David I reimplantation and Bentall technique without affecting the patient’s outcome and proving to be as safe as standard procedure in terms of hospital morbidity and mortality rates.


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