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OBJECTIVE: Minimally invasive surgery (MIS) offers an alternative to the standard full-sternotomy access to the ascending aorta. We undertook this clinical study in order to evaluate the safety of MIS for ascending aorta replacement in terms of perioperative complication rate, hospitalization time and the occurrence of major adverse cerebral or cardiac events (MACCE).
METHODS: 65 patients (75% male; age 67±12 years; BMI 30±6 kg/m²; EuroSCORE II 4.1±4.5; ejection fraction 55±9%) with ascending aortic aneurysm (diameter: 53.2±6.6 mm) underwent replacement of the ascending aorta via an upper partial “J”-shape sternotomy as follows: Supra-coronary replacement 66%, concomitant aortic valve replacement 54%, Bentall-procedure 21%, aortic valve repair/reconstruction (David-procedure) 9%, and isolated aortic root-replacement 4%. Mean operation-time was 229±84 min, CPB-time 129±62 min, aortic cross-clamp-time 97±48 min.
RESULTS: Postoperative mean ICU-stay was 1.6±1.6 days with a ventilation-time of 12.3±5 h. Through the entire cohort no re-thoracotomy for bleeding was needed; the mean chest-tube output was 528±333 ml/24h. During the ICU-stay an average of 3.5 erythrocytes concentrates, 1.1 g fibrinogen and 613 IE PPSB were needed. The overall stroke rate was 1.5%. The 30-day survival-rate was 100%. No cardiac infarction, septic event, wound disturbance or thorax instability occurred during the hospitalization period.
CONCLUSIONS: Replacement of the ascending aortic via a minimally invasive partial sternotomy requires longer operation-, bypass- and cross-clamp-times than the standard access. Nevertheless the MIS-strategy is less traumatic for the patient, providing a faster recovery, a reduced bleeding rate and a short ICU-stay. Because of its excellent results and its low MACCE-rate in the hands the experienced, we find the MIS-approach favorable for ascending aortic surgery.