Surgery of the Proximal Thoracic Aorta: A Propensity-Matched Comparison between Minimally Invasive and Full Sternotomy

Objective: Minimally invasive approaches are gaining importance in cardiac surgery and are already commonly used for the treatment of valvular diseases. Still, for operations of the proximal thoracic aorta, minimally invasive approaches are less well established. Therefore the aim of the present study was to investigate the outcome of aortic surgery via mini-sternotomy (MIS) vs. full sternotomy (FS) in a propensity score matched comparison.

Methods: This was a retrospective, observational, cohort study of prospectively collected data at the Heart Center Leipzig. At our institution, 4,707 patients underwent surgery of the proximal aorta between 1994 and 2015. Out of these patients, 257 were operated via an upper hemi-sternotomy. We were able to match 233 patients of the MIS group 1:10 with the FS control group using propensity score analysis. The mean follow-up was 3.98 ± 3.97 years.

Results: After matching the preoperative characteristics of the two groups were similar. The In-hospital and follow-up mortality was comparable between the two groups (2.2% vs. 1.5%, p =0.39 and 7.7% vs. 8.6%, p = 0.77). The postoperative outcome did not show any differences regarding respiratory dysfunction, arrhythmia, low cardiac output, myocardial infarction, cerebrovascular accident, renal dysfunction, transfusion of red blood cells, or sternal wound infections. We detected significantly more reoperations due to bleeding in the MIS group (3 vs. 0.5%, p < 0.001) but shorter ventilation times in the MIS group (31.2 ± 94.3 vs. 44.8 ± 132.6 hours, p < 0.001) and a shorter in-hospital stay (11.7 ± 7.0 vs. 13.2 ± 8.3 days, p = 0.004).

Conclusions: Surgery of the proximal thoracic aorta via a minimally invasive approach is feasible and safe. The outcome is comparable to operations via full sternotomy. Due to shorter ventilation times and reduced hospital length of stay MIS surgery is favorable for the patients and might even have the potential to reduce medical costs.