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Aortic Root Replacement And Valve Aortic Sparing Through Mini Partial Sternotomy. Single Center Experience.
Jakub P. Staromlynski, Mariusz Kowalewski, Radoslaw Smoczynski, Wojciech Sarnowski, Anna Witkowska, Maciej Bartczak, Dominik Drobinski, Piotr Suwalski.
Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
BACKGROUND: Minimally invasive cardiac surgery is becoming more and more popular. However there is still little data on minimally invasive approach for patients with aortic root aneurysm. In following study we present partial upper sternotomy approach for these patients. The objective of the current report was to report surgical data as well as remote outcomes in patients undergoing minimally invasive aortic root surgery. METHODS: Between 2011 and 2019, 177 selected low- and intermediate risk patients (mean age: 64.1±11.3; 70.1% men; EuroSCORE II 2.58±3.26) underwent minimally invasive aortic surgery. Redo-surgeries, endocarditis cases and acute dissections were excluded. The "V" shaped partial upper sternotomy was performed through a 6-cm skin incision from the notch to the third or fourth intercostal space depending on surgeons’ preference and preoperative imaging. Patients were divided into minimally invasive root repair/replacement, supracoronary aorta replacements and supracoronary aorta replacements with concomitant AVR; CPB was provided via direct aortic cannulation and two stage cannula to right atrium. According to our previous experience we set that 67 mm of aortic diameter as a exclusion criteria of minimally invasive approach. Fig 1.
RESULTS: Mean follow-up was 3.1 year (max 7.7 years). Of 177 patients, 86 (48.5%) underwent supracoronary aortic replacement surgery; 48 (27.1%) with concomitant AVR. 43 patients (24.3%) underwent minimally invasive aortic root surgery (16 cases- David/Yacob procedure; 27 cases- Bentall de Bono). Average aortic diameter was 6.00±0.46cm. In the root group the cardiopulmonary bypass and aortic cross-clamp time was 209.8.0±37.2 and 146.9±35.9. There was no case of conversion to full sternotomy in root surgery group. Median duration of intensive care unit stay was 2.0 [1.0-3.0] days. Thirty-day mortality was 0.6%. Within investigated follow-up, there was one late reoperation due to aortic valve thrombosis; remote survival was estimated at 94.7%. CONCLUSIONS:The study proved that minimally invasive aortic root surgery performed through "V" shaped partial upper sternotomy is feasible and safe in selected patients. Fig 2. 
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