ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
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Current Trends In Aortic Root Surgery: The Mini-bentall Approach.
Djamila Abjigitova, Georgia Panagopoulos, Konstadinos A. Plestis.
Lankenau Medical Center, Philadelphia, PA, USA.

Objective: Mini-sternotomy approach is becoming an accepted technique for aortic valve surgery. However, its safety for aortic root replacement has yet to be established. The aim of the present study was to compare the operative outcomes of patients who underwent aortic root replacement via mini-sternotomy (mini-Bentall) to patients who underwent conventional Bentall procedure via median sternotomy (full-sternotomy Bentall).
Methods: Between November 1998 and November 2016, 91 consecutive patients underwent the conventional Bentall procedure and 26 patients underwent the mini-Bentall procedure. The mini-Bentall procedure was performed via an upper hemi-sternotomy incision extending to the right 4th intercostal space. In large aortic aneurysms the sternal incision extended to both right and left 4th intercostal spaces.
Patients with concomitant procedures and those who underwent deep hypothermic circulatory arrest were excluded from the analysis. Using power=0.90 and α=0.05, we estimated that we needed to include 22 patients/group in order to detect a 30 minute reduction in the cardiopulmonary bypass (CPB) time in the mini-Bentall group.
We compared prospectively collected perioperative variables of both groups utilizing independent samples t-test for continuous variables and Fisher’s exact test for dichotomous variables. Not normally distributed continuous variables were compared using the Mann-Whitney U test. A p-value of < 0.05 was considered a-priori to indicate statistical significance.
Results: No significant differences were observed on the preoperative, operative and postoperative characteristics between the two groups (Table 1). The median CPB and aortic cross-clamp times in the mini-Bentall group were 169 min (range 133 - 252) and 148 min (range 113 - 181), respectively. The median duration of hospitalization in the mini-Bentall group was 6.5 days (range 4.0 - 16.0 days). There was no significant difference in intraoperative red blood cell unit utilization and other major postoperative complications (p>0.80). No conversions to median sternotomy were observed in the mini-Bentall group. In-hospital mortality was 1.1% in the group of patients who underwent the conventional Bentall procedure compared to 0% in the mini-Bentall group (p=1.00).
Conclusion: An upper hemisternotomy approach is safe and feasible in patients undergoing elective aortic root replacement surgery. Table 1. Preoperative, operative and postoperative data
Full-sternotomy Bentall (n= 91)Mini-Bentall (n = 26)p-value
Preoperative variables
Age, yearsMean: 57 ± 13Mean: 57 ± 120.94
Male74 (81.3%)23 (88.5%)0.56
Hypertension74 (81.3%)18 (69.2%)0.19
COPD12 (13.2%)2 (7.7%)0.73
Diabetes7 (7.7%)1 (3.8%)0.69
Renal Insufficiency5 (5.5%)0 (0.0%)0.59
Dialysis0 (0.0%)0 (0.0%)-
CAD14 (15.4%)2 (7.7%)0.52
Recent CVA8 (8.8%)1 (3.8%)0.68
LV Ejection Fraction (%)Median: 60 Range: 23-66Median: 60 Range: 20-700.40
Elective operation Urgent operation Emergent operation79 (86.8%) 10 (11.0%) 2 (2.2%)21 (80.8%) 5 (19.2%) 0 (0.0%)0.42
Acute dissection0 (0.0%)0 (0.0%)-
Chronic dissection9 (9.9%)0 (0.0%)0.20
Medial degeneration66 (72.5%)23 (88.5%)0.12
Marfan’s syndrome11 (12.1%)0 (0.0%)0.12
Endocarditis2 (2.2%)2 (7.7%)0.21
Pseudoaneurysm0 (2.2%)0 (0.0%)1.0
Aortitis1 (1.1%)0 (0.0%)1.0
Bicuspid aortic valve28 (30.8%)10 (38.5)0.48
Redo21 (23.1%)4 (15.4%)0.59
Intraoperative data
CPB time (min)Median: 186 Range: 128-302Median: 169 Range: 133-2520.10
ACC time (min)Median: 153 Range: 102-260Median: 148 Range: 113-1810.18
Red blood cell unitsMedian: 0 Range: 0-7Median: 0 Range: 0-60.80
Postoperative data
ICU days Median: 3.0 Range: 1.0-22.0Median: 3.0 Range: 1.0-11.00.33
Length of stay (days)Median: 8.0 Range: 4.0-35.0Median: 6.5 Range: 4.0-16.00.10
In-hospital mortality 1 (1.1%)0 (0.0%)1.00
Prolonged ventilator support 8 (8.8%)2 (7.7%)1.00
New stroke0 (0.0%)0 (0.0%)-
New renal insufficiency1 (1.1%)0 (0.0%)1.00
Reoperation for bleeding6 (6.6%)0 (0.0%)0.33
Postoperative atrial fibrillation24 (26.4%)5 (19.2%)0.61
Permanent pacemaker implantation8 (8.8%)2 (7.7%)1.00
Pneumonia4 (4.4%)1 (3.8%)1.00
Reintubation4 (4.4%)0 (0.0%)0.57
Tracheostomy1 (1.1%)0 (0.0%)1.00

COPD = Chronic Obstructive Pulmonary Disease; CAD = Coronary Artery Disease; CVA = Cerebrovascular Accident; LV = Left Ventricular; CPB = Cardiopulmonary Bypass; ACC = Aortic Cross Clamp; ICU = Intensive Care Unit


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