International Society For Minimally Invasive Cardiothoracic Surgery

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Aortic Root Surgery With Ministernotomy: Results In A Single Center
Zanxin Wang, Rui Zhang, Xianmian Zhuang, Gang Li, Minxin Wei.
Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, P. R. China., Shenzhen, China.

Background: Procedures dealing with aortic root disease through reduced chest incisions were aimed to reducing surgical trauma and improving clinical and cosmetic outcomes. However, difficulty still exists with its application in most of the operations on great arteries. The present research was designed to summarize our initial experience of aortic root surgery (including aortic valve replacement, Bentall procedure, ascending aorta replacement and aortic root plasty) by a superior ministernotomy in terms of operative indications, operative techniques, and potential benefits.Methods: Thirty-six consecutive patients who underwent aortic root surgery were retrospectively reviewed from Jan 2016 to Dec 2018. Indications were aortic valve replacement (n = 21), Bentall procedure (n = 5), ascending aorta replacement (n = 6) and aortic root plasty (n = 4). The midline incision was about 6 cm to 8 cm long. The sternum was divided in midline to the third or fourth intercostal space, which was decided by CT to evaluate the position of aortic root. To the patients with aortic aneurysm, the aneurysmalwall, especially the adventitia was not removed. It was used to cover the artificial vessel and make the aortoatrial shunt to prevent bleeding. Cardiopulmonary bypass was accomplished by femoral artery and vein cannulation. Clinical characteristics, in-hospital outcomes, and postoperative stay were recorded. Following up time was 2-35 months.Results: The patients age was 638 years old, and 21 of the 36 patients were male. There was no death, stroke or wound infection happened. Operation time was 27547 minutes. CPB time was 9115 minutes. Cross-clamping time was 4819 minutes. Ventilation time was 81 hours. Mean duration of hospital stay was 14 3 days.Conclusions: Aortic root surgery by a superior ministernotomy incision is safe and reliable. CPB with femoral artery and vein cannulation has well exposure. CT scan was much useful to decide the incision of the sternal. And the aortoatrial shunt was also a good option to prevent bleeding in aorta surgery. This procedure has many benefits of less trauma, reduction of mediastinal drainage and blood transfusion.

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