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Minimally Invasive Aortic Arch Surgery
Nora Goebel, Daniel Bonte, Schahriar Salehi-Gilani, Ragi Nagib, Hardy Baumbach, Adrian Ursulescu, Ulrich F.W. Franke.
Robert-Bosch-Hospital, Stuttgart, Germany.

OBJECTIVE: Median sternotomy is still the standard approach for surgery including the aortic arch. Minimally invasive surgery promises faster reconvalescence and shorter hospital stay plus better cosmetic results. But safety is a concern in complex aortic surgery. Aim of the study was to investigate if aortic arch surgery via partial upper sternotomy can compare to standard procedure in terms of safety and major adverse cardiac and cerebrovascular events (MACCE).
METHODS: We interrogated our prospectively collected database and identified a total of 21 non-emergent patients operated on at our center between October 2008 and February 2015. Indication for operation was aneurysmatic disease in 18 and aortic dissection in 3 patients. Data were analyzed for in-hospital mortality, stroke, bleeding complications, acute kidney injury and rhythm disturbances (pacemaker implantation).
RESULTS: Mean age of patients was 69.3 ± 14.4 years, 57.1% were female and mean logistic EuroSCORE was 17.0 ± 7.2%. Surgery on the aortic arch comprised proximal arch in 9, hemiarch in 9 and total arch replacement in 3 patients including 2 patients receiving a frozen elephant trunk. Concomitant procedures were aortic root repair in 10, aortic root replacement in 2 and aortic valve replacement in 3 patients. We lost one patient due to septic shock, we did not see any stroke, but a transient neurologic deficite in 3 and a postoperative delirium in 4 patients. Reexploration for bleeding was necessary in 2 patients, pacemaker implantation in 2 and acute kidney injury occurred in one patient.
CONCLUSIONS: Minimally invasive aortic arch surgery via partial upper sternotomy does not increase the risk of mortality or MACCE. Thus, in experienced hands, it is safe, feasible and therefore favourable and should be offered to more patients.

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