International Society For Minimally Invasive Cardiothoracic Surgery

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Minimally Invasive Ascending Aorta Replacement For Small Ascending Aortic Aneurysm During Aortic Valve Surgeries
Zhandong Zhou, Erica Comstock, Trevor Farnsworth, Charles Lutz, Ahmad Nazem.
St. Joseph Hospital, Syracuse, NY, USA.

Background: It is not uncommon that the ascending aorta needs to be replaced during aortic valve surgery for small aortic aneurysm with sizes between 4.5 to 5cm. Although minimally invasive ascending aorta and aortic valve replacement has been reported through upper sternotomy, mini thoracotomy approach for such surgery has not been well reported. With the advances in the anastomotic techniques to reduce post operative bleeding, we successfully performed a small series of combined ascending aorta and aortic valve replacement with a small 6-7 cm right anterior thoracotomy.
Methods: Between 2016 and 2018, six patients underwent ascending aorta and aortic valve replacement through a small 6-7 cm right anterior thoracotomy in the second intercostal space. The third rib cartilage was transected to provide better exposure. Cardiopulmonary bypass was established through femoral artery and venous cannulation. Distal ascending aorta was clamped with Chitwood clamp. After ascending aorta was resected, aortic valve was replaced. A Hemoshield Dacron graft was then anastomosed to the proximal and distal ascending aorta with 4-0 prolene suture and reinforced with a felt.
Results: Average age was 65.2+-7.8 year old, including 5 male and 1 female patients. Average aneurysm size was 4.68+-0.16 cm. All 6 patients completed surgery without the need of conversion to sternotomy. Average bypass time was 148+-28 minutes. Average aortic clamp time was 103+-14 minutes. Average hospital stay was 5.7+-2.2 days. All patients were discharged from the hospital in stable condition
Conclusions: Ascending aorta and aortic valve replacement can be performed safely and effectively through a small thoracotomy. A water tight anastomosis with felt enforcement is key to prevent bleeding. This may allow more aortic surgeries to be performed minimally invasively in the future.

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