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Ministernotomy Vs. Conventional Sternotomy For Aortic Root Repair: A Propensity-matched Comparison
Eduard Charchyan, Denis Breshenkov, Yuriy Belov.
Petrovsky Russian Research Centre of Surgery, Moscow, Russian Federation.

BACKGROUND: Aim of our study to compare the results conventional aortic root repair with minimally invasive (MI)
METHODS: A total of 881 patients undergoing aortic root surgery from 2013 to 2020 at our center. MI aortic root repair was performed of 198 (22.4%) patients through J-shaped ministernotomy. Of them, we included 77 patients (39%) with aortic root repair (Bentall-DeBono (n=43) and David (n=34) procedures) according to inclusion criteria. Propensity score matching produced 77 (ministernotomy vs. conventional sternotomy (CS) well-matched pairs (Fig 1.). Primary endpoints were in-hospital mortality and major adverse postoperative events; secondary endpoints included aortic re-intervention, all complications, and survival.RESULTS: The cardiopulmonary bypass (CPB) and aortic cross-clamp (AoX) times were significantly longer in the MI group compared to the matched CS group (Table 1). Blood loss (950(800-1200) ml vs. 700(600-800) ml, p<0,001), postoperative drainage loss (500(360-680) ml vs. 360(300-480) ml, p<0,001), ventilation time (6(5-8,23) h vs. 5(4-7) h, p = 002), ICU stay (1,30,5 d vs. 1,10,7 d, p = 0,0431) and hospital stay (8,92,5 d vs. 8,12,1 d, p = 0,0331) were lower in MI group. There was no in-hospital mortality in both groups. No significant difference in the incidence of major postoperative complications was observed. Median follow-up was 41(9-57) and 15(3-30) months in CS and MI group accordingly. Freedom from reoperations (94,7% vs. 78,9%, log rank = 0,28), survival (89,4% vs. 94,3%, log rank = 0,13) were no difference.CONCLUSIONS: This study showed that MI aortic root surgery is an effective, safe and reproducible procedure. MI techniques demonstrate equivalent early and midterm postoperative outcomes to CS and may reduce blood loss, ventilation time, ICU and hospital length of stay but increase CPB and AoX times.

Perioperative results
Group CS (n=77)Group MI (n=77)p
CPB (Bentall), min88(76-101)102(91,5-113)0.002
CPB (David), min13025,514119,60,013
AoX (Bentall), min71(59-84)82(75-90)0.002
AoX (David), min108(100-118)123(111-135)0.002
Blood loss, ml950(800-1200)700(600-800)<0,001
Ventilation time, h6(5-8,23)5(4-7)0,002
ICU stay, day1,30,51,10,70,0431
Hospital stay, day8,92,58,12,10,0331
Postoperative drainage loss, ml500(360-680)360(300-480)<0,001


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