Minimally Invasive Versus Conventional Approach For Aortic Root Surgery: Propensity Score Matching Analysis
Anastasiia Karadzha, Alexander Bogachev-Prokophiev, Ravil Sharifulin, Alexander Chernyavskiy.
Meshalkin national medical research center, Novosibirsk, Russian Federation.
BACKGROUND: The aim of this study was to compare the safety and effectiveness of using a minimally invasive approach (partial sternotomy) versus a conventional approach (median sternotomy) for aortic root surgery. While the partial sternotomy is preferred for isolated aortic valve replacement due to its optimal operating conditions and excellent cosmetic results, it is not commonly used for aortic root surgery and the conventional median sternotomy is still the preferred method for most surgeons. The study sought to determine if the minimally invasive approach could be a viable alternative for aortic root surgery.METHODS: Consecutive patients who underwent aortic root surgery at our hospital from 2016 to 2021 were retrospectively collected, and the cases were divided into two groups: a standard approach through the conventional sternotomy (CS) group, comprising 198 patients, and a minimally invasive approach through the upper hemisternotomy (MS) group, comprising 47 patients. After matching the patients in each group based on various characteristics (gender, age, BMI, aortic valve morphology, NYHA function class, type of procedure) using propensity score matching, two equal groups of 41 patients each were obtained.RESULTS: Bicuspid aortic valves were observed in 18 patients (43.9%) in the CS group and 23 (56.1%) in the MS group (p = 0.532). The David procedure was performed in 25 (60.9%) cases and the Bentall de Bono procedure in 15 (29.1%) cases in both groups. A comparison of the outcomes of the two groups showed that the minimally invasive approach had benefits in terms of mean blood loss, rates of plasma transfusion, and mean duration of inotropic therapy during the first 24 hours after surgery (p = 0.004, p = 0.037, and p = 0.047, respectively). Other studied criteria did not significantly differ between the two groups after propensity score matching. The mean follow-up period was 17.3±14.8 months for the CS group and 16.8±12.6 months for the MS group. There were no cases of early or late mortality. The 3-year freedom from reoperation or severe aortic regurgitation after the David procedure was comparable in the standard and minimally invasive groups (p = 0.556).CONCLUSIONS: A minimally invasive approach for aortic root surgery can be performed safely and with similar results as the standard approach. The mini J sternotomy has the advantage of lower blood loss in the early postoperative period compared to the conventional median sternotomy. The minimally invasive approach does not negatively impact the results of valve-sparing root replacement at the mid-term follow-up. 
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