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OBJECTIVE: Ascending aortic aneurysm with root extension and aortic valve dilatation is rather more challenging procedure and usually full sternotomy is used. The aim of the study was presenting minimal invasive approach as possible access for the Bentall de Bono procedure.
METHODS: 7 elective patients from 54 minimal invasive aneurysm operations prepared between 2011-2013 in our center were subanalyzed. Mean age was 54,14±13,17 (100% male). All patients had ascending aorta aneurysm with bicuspid aortic valve insufficiency amenable to repair. V-shape mini upper-sternotomy to 3rd intercostal space was done for the minimally invasive access. Additional 2 cm incision under xiphoid process was done for venous cannula and vent. Bio-conduits were prepared suturing latest generation biological valve to aortic graft during procedures. Aortic valve and ascending aorta were replaced in Bentall de Bono technique.
RESULTS: Bio-conduits were implanted in 5 young patients aware of their own decision. 2 patients had manufactured conduit with a mechanical valve. Overall valve size was 25,9 mm. Mean cross-clamp was 145,71±20,41 minutes, cardiopulmonary bypass time (CPB) was 199,57±45,25 minutes. Postoperatively 1 patient required packing as consequence of tissue bleeding which were successfully removed after 2 days. 30-days mortality was zero. Postoperative echocardiography showed one digit mean gradients through biological aortic prosthesis. Mean follow-up was 14,4 months without Major Adverse Cardiac and Cerebrovascular Event (MACCE) and good echocardiographic parameters (mean gradients 7,4mmHg, peak gradients 16,2 mmHg). All patients were in NYHA functional class I with stable sternum and good cosmetics effect of the surgical wound.
CONCLUSIONS: Mini upper-sternotomy can be expanded to ascending aorta and valve replacement using Bentall de Bono technique which is in our experience feasible, repeatable and safe.