Minimally invasive approach in patients with aortic aneurysms in consecutive patients.
Jakub P. Staromłyński, radoslaw smoczynski, Witkowska Anna, Pawel Stachurski, Sarnowski Wojciech, Suwalski Piotr.
Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
Minimally invasive cardiac surgery is becoming more and more popular. However there is still little data on minimally invasive approach for patients with aortic aneurysm.
Between November 2011 and November 2016 103 patients with aortic aneurysms were included to our study. The surgical access was via mini upper partial V sternotomy through 3rd or 4th intercostal space. CPB was provided via direct aortic cannulation and two stage cannula to right atrium. According to our previous experience we set that 70 mm of aortic diameter as a exclusion criteria of minimally invasive approach.
Totally we performed 103 minimally invasive procedureIn 67 patients (47,8%) we performed supracoronary graft, in 29 patients (20,7%) supracoronary graft and AVR, in 26 patients (18,5%) we performed Bentall procedure (mechanical graft), in 10 patients (7,1%) Bio-Bentall procedure and in 8 patients ( 5,3%) David procedure. . Mean (SD) age was 62.9±12,0 years; mean BMI (kg/m2) was 29,0 ±4,4. Preoperative comorbidities included insulin-dependent DM in 12,6% , previous PCI in 4,8. The mean EF was 58.2±7.8 %. The mean EuroScore II was 2,6±3,0 %. In all group we did not observe conversion to full median sternotomy. Reopening for bleeding was necessary in 5 patients (4,8%). We didn't observe any neurological incidents, deep wound infection and vascular complication. In 5 patients were observed superficial wound infections required aimed antibiotical therapy. The average stay in ICU were 2.2± 2.1 days. In first 12 hours 68 % patients were extubated. During first 24 hours we observed mean drainage- 357,4±206,4 ml. Blood transfusion rate was: 0.8±1,2, platelets transfusion was 0,3± 1.2. 30 days mortality was 0,97 %.
Minimally invasive procedures via mini upper partial V sternotomy are safe and feasible methods in consecutive all-comers. Due to decreased tissue traumatization it provides better haemostasis. Small incision and only partial upper sternotomy enable faster recovery. In this group of patients the most benefits were observed in: early extubation (chest stability), very low hospital mortality.
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