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OBJECTIVE: The partial upper sternotomy approach is well described in literature for aortic valve replacement, with proven better outcomes in terms of faster recovery and lower risks of wound complications. More complex aortic procedures are being performed through the same access to achieve similar benefits, but only few centers do it extensively. We describe our experience with aortic root surgery performed through this minimally invasive approach.
METHODS: From January 2010, 234 patients were scheduled for aortic root replacement at our institution. Sixty-two of them (26.5%) were selected to receive a partial upper sternotomy. The Bentall-De Bono technique was performed in 37 patients, while a valve-sparing approach (David I) was possible in the remaining 25. The median age was 56 years (range 17-83) and most patients were males (83.9%). Twenty-five patients (40.3%) had a bicuspid aortic valve.
RESULTS: Median cardiopulmonary bypass time was 120.5 (67 - 235) minutes and aortic cross clamp time was 102.5 (57 - 205) minutes. Intensive care and total length of stay were respectively 1.9 days (median) and 7 days. A re-exploration for bleeding was necessary in four patients. Only one patient reported a sternal wound infection. The in-hospital mortality was 3.23%. No conversion to full sternotomy was necessary.
CONCLUSIONS: According to our experience, the partial upper sternotomy is a safe access for aortic root surgery. Descriptive analysis data on hospital morbidity and mortality rates are similar to those operated via full sternotomy at our department, although a propensity score matching comparison is necessary to confirm the effective safety of the minimally invasive approach.