Minimally Invasive Versus Conventional Aortic Root Surgery: Mid-term Results In A 2-year Follow-up
Mahmoud Elghannam, Yazan Aljabery, Vadim Moustafine, Markus Schloemicher, Matthias Bechtel, Justus Strauch, Peter Haldenwang.
BG University Hospital Bergmannsheil Bochum, Bochum, Germany.
Background: Although full median sternotomy (FMS) is the standard access to the aortic root, minimally invasive surgery (MIS) via a partial upper sternotomy (PUS) represents an alternative with less trauma and a better cosmetic result. Aim of our study was to report our 2-year experience with MIS for aortic root surgery and to analyze the outcome in patients who underwent Bentall- and David-procedures with PUS versus those who had the same procedures via FMS.
Methods: Between 11/2011 and 02/2019, n=94 consecutive patients with aortic aneurysm and/or localized aortic dissection underwent aortic root surgery: 62 patients (73% males, 58±10.7 years) were operated via J- shaped PUS. 33 patients (61% males, 64.5 ± 10.1 years) underwent the same procedures via FMS. In the PUS-group, 49 received a Bentall- and 13 a David-procedure. In the FMS-group 26 patients underwent a Bentall- and 7 a David-procedure. The 30-day outcome of mortality, stroke and myocardial infarction rate were assessed. The postoperative follow-up was competed by interviewing the patients and their physicians in a 6-month, 1-year and 2-year interval.
Results: Operation times were 286±61 vs. 297±64 minutes for PUS and FMS, respectively. Cardiopulmonary bypass and cross-clamp times were 176±51 and 134±31 minutes in the PUS-group vs. 182±52 and 131±34 minutes in the FMS-group. The re-thoracotomy rate due to postoperative bleeding was 9% in PUS- vs. 3% in FMS-group. One superficial wound healing disturbance without sternum instability occurred in the PUS-group. Hospitalization was 11±4.5 for PUS vs 14±5.9 days for FMS; ICU-stay was 1.9±1.2 vs 3±2.9 days. Ventilation-time in PUS-patients was 10.6±5.3 in the PUS- vs. 13.5±14 hours in FMS -group. There was one case of stroke in PUS- and one in the FMS-group. The 30-day-mortality was 0% in both groups. After 2 years the mortality and reoperation rates were 1.6% and 6% in the PUS-group vs 6% and 9% in the FMS-group.
Conclusions: MIS of the aortic root via PUS is a safe alternative to the standard FMS-access. It requires a longer learning curve due to the limited operation field, but offers less trauma and a faster recovery with an excellent early and mid-term result, when compared to conventional FMS-surgery.
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