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Mini-Bentall: an attractive approach for elective patients
Elisa Mikus, Marco Pagliaro, Alberto Tripodi, Diego Magnano, Mauro Del Giglio.
Maria Cecilia Hospital, GVM for Care & Research, Cotignola (Ra), Italy.

OBJECTIVE: Minimally invasive surgery through an upper “J” sternotomy for aortic valve replacement has become routine approach with excellent results. Complex ascending aortic procedures are performed through the same minimally invasive access only in few Centers. We describe our experience using either standard full sternotomy or minimally invasive approach for Bentall operation.
METHODS: From January 2010 to October 2015, 240 patients received elective ascending aorta and aortic valve replacement using Bentall De Bono procedure at our Institution.
Out of 240 patients operated, 53 had minimally invasive ministernotomy and 187 had full median sternotomy. Median age was 63 years (25th percentile=51; 75th percentile=73) for the minimally invasive group and 68 (25th percentile=54; 75th percentile=73) for the full sternotomy one (p=0.365). No statistically significant differences in terms of body mass index (p=0.678), left ventricular ejection fraction (p=0.319), Diabetes mellitus (p=0.988), chronic obstructive pulmonary disease (p=0.5) and renal insufficiency (p=0.198) have been found between the two groups.
RESULTS: The partial sternotomy was performed from the notch to the 3rd right intercostal space. A Bentall De Bono procedure, using a pericardial Mitroflow bioprosthesis implanted in a Valsalva graft or a standard mechanical conduit, was performed in all patients. Median cardiopulmonary bypass time and median cross-clamp time were respectively 84 (74.25-103) min and 73 (64-89) min for the minimally invasive group and 101 (80-133) min and 81 (67-112.5) min for the full sternotomy one, with significant difference (p=0.007 and p=0.029). Post operative ventilation time resulted lower in patients treated with ministernotomy: median was 8 versus 8.5 hours without statistically difference (p=0.069) as well intensive care unit stay (p=0.281), incidence of atrial fibrillation (p=0.62) and hospital mortality (p=0.126).
CONCLUSIONS: Our experience confirms that a minimally invasive approach using a partial upper “J”-shaped sternotomy could be an attractive and safe alternative approach to the standard one also in selective patients affected by complex aortic root pathology.

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