BACKGROUND: A minimally invasive approach has become a popular technique in cardiac surgery. However, its safety in aortic root replacement is yet to be established. The present study aimed to evaluate the safety and feasibility of the mini-Bentall procedure via a right anterior mini-thoracotomy (RAMT) in a single center.
METHODS: The baseline, perioperative, and follow-up data of 74 patients who underwent mini-Bentall surgery via an RAMT between September 2020 and July 2023 in our hospital were retrospectively reviewed. In the same period, 62 patients were performed a Bentall surgery through a median sternotomy (MS). Patients’ follow-up was conducted by the phone after the surgical procedure. The Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) and Shor Form-36 (SF-36) were used to record patients’ health-related quality of life during the follow-up.RESULTS: After propensity score matching, 51 patients remained in each group. Cardiopulmonary bypass time (151[139,176] vs 118[100, 144], p<0.001) and aortic crossclamp time (117[101,144] vs 89[74,106], p<0.001) were significantly higher in the RAMT group than in the MS group. On the other hand, bleeding during operation (200[200,250] vs 100[100,200], p<0.001), ventilation time (16.5[6, 24] vs 11[6, 20], p<0.001), chest tubes drainage of the fist 24h (420[310, 590] vs 170[130,330], p<0.001), drainage time (6[5,8] vs 5[4,6], p<0.05), the intensive care unit length of stay (3[2,4] vs 5[4,6], p<0.001), hospital stay (16[14,20] vs 14[11,18], p<0.05) and CRP (40.5[23.8,60.6] vs 34.8[17.3,47.3], p<0.05)were higher in the MS group than in the RAMT group. Hydropericardium requiring puncture was significantly higher in the RAMT group than in the MS group (11.8% vs 0, p=0.027). While, the blood transfusion in MS group remains significantly higher compared with RAMT group (47.1% vs 23.5%, p=0.022). The general health score (72.33±18.59 vs 59.31±23.37,p=0.016) of SF-36 and physical limitation score (89.70±14.10 vs 79.86±24.02, p=0.024 ) of KCCQ-12 were significantly higher in RAMT compared with MS group.
CONCLUSIONS:The mini-Bentall procedure through an RAMT is a feasible and safe approach with good clinical results in patients undergoing aortic root replacement.
