BACKGROUND: Minimally invasive aortic valve has demonstrated advantages over conventional sternotomy including shorter ICU and hospital lengths of stay, shorter ventilation time, and reduction in blood transfusion. At experienced centers, these minimally invasive techniques have been applied to more complex aortic surgery, including the Bentall Procedure. The Bentall Procedure was first described in 1968 and involves a composite graft replacement of the aortic valve, root, and ascending aorta with reimplantation of the coronary arteries. Recently, this procedure has been performed via upper hemi sternotomy and right anterior thoracotomy. We previously reported single-center data on seven patients who underwent a minimally invasive Bentall procedure with and without the use of automated suturing devices. We demonstrated excellent clinical results with these initial patients and continue to apply this technique in select patients. The objective of the present study is to provide further support for the safety and feasibility of the mini Bentall performed via a right anterior thoracotomy after an additional 42 cases. To our knowledge, this represents the largest single-center case series published to date.
METHODS: We identified all cases of Bentall procedure performed via right thoracotomy. Variables were abstracted from the electronic record. Descriptive statistics were calculated.
RESULTS: A total of 49 mini-thoracotomy Bentall procedures were performed, with 4 converted to open. The average age was 55.0. Average aortic cross-clamp and cardiopulmonary bypass time were 151.2 and 199.9 minutes, respectively. Mean deep hypothermic circulatory arrest time was 25.4 minutes. Average time to extubation was 11.2 hours post-op (median 10 hours), with a mean overall length of stay of 6.58 days (median 5 days). Of the cases converted to sternotomy, one passed away 98 days postoperatively. This was the only death in this cohort, with a mean follow-up of nearly 4 years. Of patients with greater than 1 and 5 years of postoperative follow-up, survival remains 100%.
CONCLUSIONS: While careful patient selection and surgeon experience in minimally invasive cardiac surgery are essential elements of success, these data show seven years of favorable outcomes for the right mini-thoracotomy Bentall procedures. This approach can provide a safe and feasible sternal-sparing alternative to conventional Bentall.
