The Role Of Ministernotomy Approach In Surgical Treatment Of Ascending Aorta Pathology
Volodymyr Vayda, Vasyl Lazoryshynets, Vitaliy Kravchenko, Igor Zhekov.
National Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine.
BACKGROUND - To improve the results of surgical treatment of ascending aorta pathology in combination with aortic valve disease using various surgical techniques by minimizing operative trauma for the purpose of rapid physical recovery of patients.METHODS - In National Amosov Institute of Cardiovascular Surgery from 01/01/2015 to 01/01/2019 70 patients were operated due to pathology of ascending aorta. In all patients we used upper J-shaped ministernotomy approach. Depending on the type of surgery, all patients were divided into three groups. Group A included 45 (64.3%) patients who underwent aortic valve replacement in combination with exoprosthetics of the ascending aorta. Group B included 16 (22.9%) patients who have undergone ascending aorta replacement by various techniques. 9 (12.8%) patients of group C underwent an isolated external aortic root suppport surgery on the beating heart.RESULTS - There were no lethal outcomes. The intervention time was 220-380 minutes (mean 285 ± 33 minutes). Mean crossclamp time was 104 ± 28 min. Intraoperative blood loss in all cases did not exceed 400 ml. Blood loss in the first postoperative day ranged from 50 to 300 ml (average 125 ± 19 ml). Mechanical ventilation on average lasted 4.5 ± 0.5 hours after the intervention. All patients were transferred from the intensive care unit within 36 ± 3.5 hours after surgery. In group C the duration of the operation was 140-240 minutes. (average 163 ± 15 min.). Blood loss - 50-200 ml (average 135 ± 19 ml). Complications of this technique were noted by us in 5 (7.1%) patients. In other cases, faster rehabilitation of patients was noted, pain complaints were less pronounced, and therefore less need for pain medication.CONCLUSIONS - Ministernotomy approach in surgical treatment of pathology of ascending aorta using various surgical techniques minimizes surgical trauma, provides a good cosmetic effect and can be applied in clinical practice as an alternative to median sternotomy.
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