Complete Central Cannulation For Minimally Invasive Tirone David Procedure Via Partial Upper Sternotomy
Gabriele Tamagnini, Raoul Biondi, Diego Magnano, Enrico Ramoni, Vincenzo Smorto, Josč Luis Zulueta, Mauro Del Giglio.
Villa Torri Hospital, 12, Bologna, Italy.
Objective: Demonstrate technical safety and feasibility of complete central cannulation in a Tirone-David procedure via partial mini-uppersternotomy. Minimally invasive surgery helps to reduce blood loss, post-operative pain and to improve the recovery. This procedure can be carried out with good results avoiding peripheral cannulation: we strongly believe that the total central cannulation technique is pivotal to avoid all the disadvantage of a retrograde perfusion and the surgical trauma to expose the femoral vessels. Methods: Retrospectively, from July 2010 to May 2018, we collected 84 consecutive patients, undergoing Tirone-David procedure for aortic root with or without aortic valve disease. A minimally invasive approach via mini-uppersternotomy with a 7-cm skin incision was performed in a single-Surgeon setting with complete central cannulation, normotermic systemic perfusion and blood-based cardioplegia. Based on our experience we simplified the procedure: we use a systematic approach to assess the potential valve disfunction and to measure the optimal vascular graft size.
Results: All procedure went successfully. Total central cannulation (inflow to the proximal aortic arch and outflow to the right atrium) was performed in every case.Population: male 81% with a mean age of 52,6±14,4 yrs; the mean STS score 1,92% ±0.86%. Results: the mean CPB duration was 138,5±19,7 minutes with an aortic cross-clamping time of 124,1±19,7 minutes; the mean ventilation time was 5,4±2,1 hours; mean ICU stay was 2,1±1,2 days. The total in-hospital stay mean duration was about 8 days. Observed 30-day mortality rate was 1,2%. None of our patients had aortic regurgitation more than mild at discharge. Half of the patients was discharged home, 36.9% to rehabilitation centers and the rest to other Institutions.At our 5-year follow-up 97% of patients were alive with a 91% of freedom from aortic regurgitation more than mild. Conclusion: The Tirone-David procedure is an effective option for aortic valve and/or root disease, with good result even in a minimally-invasive approach. Beyond a better cosmetic results, a less invasive approach allows a faster return to the normal life.
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