Ascending Aortic Replacement Through A Ministernotomy Approach
Oleg Orlov, Vishal Shah, Cinthia Orlov, Manabu Takebe, Konstadinos Plestis.
Lankenau Medical Center, Philadelphia, PA, USA.
BACKGROUND: Mini-sternotomy (MS) aortic valve surgery has become routine in our institution for the last 10 years. This study aims to examine the feasibility of utilizing MS for ascending aorta replacement with or without aortic valve surgery (AVS). METHODS: We retrospectively analyzed all patients who underwent elective ascending aortic replacement with or without AVS between January 2000 and October 2017. Fifty-seven (38%) patients had MS and 93 (62%) had full sternotomy (FS). For a MS procedure, we utilized a six centimeter upper partial sternotomy with extension into the right 3rd intercostal space. The aortic arch was directly cannulated and a venous cannula was placed in the superior vena cava via the right common femoral vein. RESULTS: The mean age at operation was 64.1 years (59% males) in the FS group and 61.5 years (63% males) in the MS group. The FS group had a higher incidence of medial degeneration (62.4% vs. 42.1%, p=0.017) and a lower incidence of bicuspid aortic valve (33.3% vs. 56.1%, p=0.007) compared to the MS group. There was no difference in elective operations (88.2% vs. 96.5) and redo procedures (4.3% vs. 10.5%) in FS and MS groups respectively (p>0.1). Thirty-eight (41%) patients underwent AV replacement and 20 (21.5%) patients underwent repair in the FS group. Twenty-nine (51%) underwent AV replacement and 8 (14%) patients underwent repair in the MS group. Hospital mortality was low in both FS and MS groups (1.1% vs. 0%, p=1). The incidence of stroke, renal insufficiency, prolonged ventilatory support and return to OR for postoperative bleeding were similar between the two groups (p>0.24). Postoperative pleural effusion (3.5% vs. 15.1%) and atelectasis (0% vs. 9.7%) was significantly lower in the MS group (p<0.03). Hospital stay was 7.6 days in the FS group compared to 6.6 days in the MS group (p=0.15). CONCLUSIONS: MS ascending aortic replacement is feasible for a select group of patients with excellent outcomes. Larger studies are necessary to validate our hypothesis.
LEGEND: FS vs. MS in ascending aorta replacement 
Back to 2018 ePosters