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Aortic root surgery through lower partial sternotomy
Kenji Minatoya, Yoshimasa Seike, Tatsuya Oda, Yosuke Inoue, Tatsuya Itonaga, Hiroshi Tanaka, Hiroaki Sasaki, Junjiro Kobayashi.
National Cerebral and Cardiovascular Center, Osaka, Japan.

OBJECTIVE: Partial sternotomy has been established as one of approaches for cardiac surgery. The approach, however, is not well established yet for aortic surgery. Recently upper partial sternotomy has been reported for aortic root replacement. We have applied lower partial sternotomy for the aortic root replacement.
METHODS: Since 2013, 34 patients (42.2+-14.2 years, range 14-66, 17 male) underwent aortic root surgery through lower partial sternotomy. The preoperative diagnoses were annuloaortic ectasia in all, and 21 patients showed aortic regurgitation. Nineteen patients had connective tissue disorder including Marfan syndrome. The skin incision was 15cm at the beginning; however, it is shortened to 7cm recently.
RESULTS: Skin incision was 9.8+-2.5cm. Valve-sparing root replacement was performed in 31 patients, composite graft replacement was performed in 3. As concomitant procedures, mitral valve repair was performed in 3 patients, ASD closure was performed in 1, and Maze procedure was performed in 1. Twenty-nine patients had open distal anastomosis, and they all had antegrade or retrograde cerebral perfusion under hypothermia. Cardiopulmonary bypass time was 296+-65 min., cardiac ischemic time was 247+-53 min., lower body circulatory arrest was 19.2+-5.8 min. There was no hospital mortality. No postoperative cerebral and renal complications were found. One patient had mediastinitis. One patient after valve-sparing root replacement needed reoperation due to graft infection 2 month after the first operation.
CONCLUSIONS: All operations through the partial sternotomy were performed safely under fine exposure. Lower partial sternotomy has a more cosmetic benefit. The partial sternotomy could be an excellent option for aortic operations in selected patients.

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