Minimally Invasive Versus Conventional Approaches In Aortic Root Surgery
Andrey Sapegin, Alexander Bogachev-Prokophiev, Ravil Sharifulin, Anastasia Karadzha, Mikhail Ovcharov, Alexander Afanasyev, Sergey Zheleznev, Alexander Chernyavskiy.
Meshalkin National Medical Research Center, Novosibirsk, Russian Federation.
BACKGROUND
Mini-J sternotomy has become the “gold standard” approach for isolated aortic valve replacement however is challenging procedure for aortic root surgery. METHODS The retrospective study included 185 patients with aortic root aneurysms and aortic valve diseases who underwent isolated David or Bentall procedures from 2016 to 2018. Minimally invasive (MIARS, n=24) and conventional (CARS, n=48) aortic root surgery groups were formed using 1:2 propensity score matching. All operation in MIARS group was performed through a minimally invasive upper hemi-sternotomy with central arterial femoral vein cannulation. RESULTS Cardiopulmonary bypass and cross-clamping periods were comparable between groups. After PSM there were significant between group differences in blood loss index, re-exploration for bleeding, ventilation and ICU-staying times. Where were no significant differences in perioperative mortality, stroke, myocardial infarction and pacemaker implantation rate. According to behavioral pain scale and analgesics requirement patients from MIARS group had benefits in comparison with CARS subsets. CONCLUSION Minimally invasive approach in aortic root surgery does not increase early mortality and morbidity and has shown advantages in blood lost, ICU staying time and analgesics requirement. 
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