Minimal Invasive Aortic Surgery: Safe And Feasible
Theodor Fischlein, Joachim Sirch, Giuseppe Santarpino.
Klinikum Nürnberg - Paracelsus Medical University, Nuremberg, Germany.
OBJECTIVE: Aortic surgery is often a surgical challenge and there are doubts about its feasibility in minimally invasive approach. We described our experience in aortic procedures performed in minimally invasive approach.
METHODS: Since 2011, a total of 39 consecutive patients underwent an aortic procedure (36 patients with associated aortic valve surgery, 2 patients only ascending, 1 patient also with aortic arch). It is a single surgeon experience. We recorded the peri- and postoperative outcome to detect the safety and the feasibility.
RESULTS: Four patients had an urgency indication, the other 35 were “elective”. Two patients were “Redos”. Mean age was 64 years old (min 18 - max 84). Logistic Euroscore was 21 (min 4 - max 84). X-clamp time was 104 minutes (min 52 - max 166), cardiopulmonary bypass time 185 minutes (min 100 - max 317), surgical time 309 minutes (min 193 - max 526). About the transfusions: intraoperative 1.2units/patient, postoperative 2.8units/patient. Mean drainage was 610 mL and a need of re-thoracotomy was needed in 6 patients (15%). 1 patient recorded a sternal instability, no neurological complications were recorded. 3 patients underwent tracheotomy and 2 received a temporary dialysis. ICU stay was 4.5 days. 3 patients died, 2 (5%) for cardiac reasons.
CONCLUSIONS: Minimally invasive aortic surgery is a safe and feasible in different patient categories; low to high risk and also in the urgency setting. It is no time demanding and it permit, especially, a good neurological outcome. Reproducibility by different surgeons and its use without patients´ selection has to be demonstrated.
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