Early And Midterm Outcomes After Aortic Root Replacement Via Mini Vs. Full Sternotomy
Cinthia Orlov1, Oleg Orlov1, Vishal Shah1, Manabu Takebe1, Roseline Atchori2, Serge Sicouri2, Scott Goldman1, Konstadinos Plestis1.
1Lankenau Medical Center, Wynnewood, PA, USA, 2Lankenau Medical Center, Philadelphia, PA, USA.
Purpose: Ministernotomy is an attractive option for proximal aortic procedures because it may allow for faster recovery and less postoperative pain. This study investigates the feasibility and safety of mini-sternotomy in aortic root replacement. Methods: Between 2000 and 2018, 142 consecutive patients underwent aortic root replacement. Forty-four patients underwent mini-sternotomy (MS) with extension to the right 3rd or 4th intercostal space. Ninety-seven patients underwent full sternotomy (FS). Exclusion criteria were cases involving acute dissection, deep hypothermia, and circulatory arrest, arch and hemi-arch, root abscess and concomitant procedures. FS group had significantly more Marfan patients (12.4% vs. 0%, P=0.01) and a trend towards more chronic dissections (0 vs. 8.3%, P=0.06). Medial degeneration (95.6% vs. 73.2%, P=0.001) and hypercholesterolemia (55.6% vs. 30.9%, P=0.006) were significantly more common in MS group. Results: Hospital mortality was 0% in MS vs. 1% in FS (P=ns). Stroke rate was 2.2% vs. 0% in MS compared to FS (P=ns). The rate of reoperation for bleeding was 0% vs. 5.2%, renal insufficiency was 0% vs. 0%, atrial fibrillation 24.4% vs. 23.7%, and prolonged ventilatory support was 8.9% vs. 9.3% in MS vs. FS groups, respectively (P=ns). Median bypass and cross-clamp times were 153 mins and 141mins for MS group and 187 mins and 167 mins for FS group, respectively (P<0.05). No differences in transfusions of PRBCs (1.0 vs. 1.5), FFP (1.3 vs. 1.3), and platelets (1.1 vs. 1.2) were noted in either group. Transfusion of cryoprecipitate was more frequent in FS (1.5 vs. 1.2, P=0.01). The median intubation time was shorter in MS (6 vs. 17.5 hours, P<0.001). The mean length of stay in MS and FS groups was 8 and 9 days respectively (P=0.14). The survival at 1-, 2- and 3-years was 100% vs. 99%, 100% vs. 99% and 100% vs. 98% for MS and FS patients respectively (P=0.54) (Figure 1). Conclusion: Mini-sternotomy is feasible with similar intra- and postoperative outcomes and comparable midterm survival to full sternotomy. Further studies are needed to assess the quality of life metrics and long-term survival.
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