Comparison Of Different Surgical Approaches For Ascending Aortic Surgery: Right Anterior Minithoractomy And Conventional Median Sternotomy
Fatih Gumus1, Mustafa Serkan Durdu2.
1Bartin State Hospital, Bartin, Turkey, 2Ankara University, Ankara, Turkey.
BACKGROUND: Minimally invasive approaches to the aortic root and ascending aorta are increasingly being performed. We aimed to present our initial clinical experience and show the feasibility and safety of RAT approach for ascending aorta surgery with or without aortic valve involvement.
METHODS: This single center study was included 112 patients who underwent ascending aortic replacement with or without aortic valve intervention, between September 2018 and December 2021. RAT was performed for 48 (42.9%) patients and conventional median sternotomy was performed for 64 (57.1%) patients. The primary endpoints included operative variables (total operation time, cardiopulmonary bypass time, and aortic cross-clamping time), reoperation for bleeding, transfusion requirements and postoperative complications. Secondary endpoint was 30-day mortality.RESULTS: Of the 112 patients, 48 (42.9%) were treated by using a minimally invasive right anterior thoracotomy approach, and the remaining 64 (57.1%) were treated by using a standard sternotomy approach.Mean age of patients was 67.63±6.67 years, and 65.1% of patients were male. Mean logistic EuroScore II was 2.24±0.81. There was no significant difference between two groups in demographic data. . When we compared the cardiopulmonary by pass (CPB) time, aortic cross clamping (ACC) time and hypothermic circulatory arrest (HCA) time as we expected, there were no significant differences between two groups. Total operating time was statistically significant lower in favor of RAT group (237.84±24.87 min vs 259.57±27.41 min, respectively, p=0.0001). When we compared the postoperative variables of patients between the RAT group and the sternotomy group, the mean ventilation time (12.73±2.96 hours versus 19.43±4.21 hours) and the mean ICU length of stay (1.71±0.86 days versus 3.6±1.71 days) were both shorter in the RAT group (p<0.0001 for both).length of hospital was significantly shorter in RAT group compared to sternotomy group (7.48±0.91 days versus 10.6±1.43 days, p<0.0001), hospital mortality was similar between two groups. CONCLUSIONS:Right anterolateral mini-thoracotomy is a novel and promising approach for ascending aortic surgery with or without aortic valve involvement. This study suggests that this approach is both feasible and safe.
Back to 2022 Display Posters