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OBJECTIVE: Minimally invasive AVR is an increasingly accepted technique. Aortic root replacement (ARR), however, is technically more challenging, meaning few centres perform it through a minimally invasive approach and with very little data published. After establishing a mini aortic valve programme, we have extended this expertise to aortic root surgery. We sought to compare our full sternotomy (Standard-Root) and minimally invasive (Mini-Root) approaches.
METHODS: One surgeon started performing Mini-Roots from April 2012. We retrospectively analysed our prospectively maintained database and reviewed the surgeon’s isolated ARR practice over an 18-month period (April 2012 - September 2013). Surgical approach was according to patient and surgeon choice. Surgery was performed through a mini-sternotomy via the 3rd intercostal space.
RESULTS: Nine Standard-Roots and 7 Mini-Roots were performed. Pre-operative demographics and risk scores were similar. Mean additive EuroSCORE Standard-Root 8.9 versus Mini-Root 7.7. Mean CPB time 108 versus 114mins and cross-clamp time 75 versus 88mins were longer for the Mini-Roots. No Mini-Roots were converted. Post-operative blood loss was less for the Mini-Roots (436 versus 246ml) and fewer patients received blood transfusions (mean 56% versus 14%). Post-operative complications were similar in both groups with no deaths or strokes. Length of stay (8.4 versus 5.7days) was shorter in the Mini-Root group.
CONCLUSIONS: We have demonstrated that aortic root surgery through a mini-sternotomy is feasible with at least equivalent results to a full median sternotomy, permitting further cases to be performed for validation. Our experience has shown potential benefits of a Mini-Root include reduced blood loss, less transfusion and shorter hospital stays.