Minimally Invasive versus Conventional Aortic Root Surgery: Mid-Term Results in a 2-Year Follow-up

Objectives: To evaluate the safety and outcome of partial upper sternotomy (PUS) compared with full median sternotomy (FMS) in aortic root surgery.

Methods: Between 11/2011 and 02/2019, a total of 94 consecutive patients with aortic aneurysm and/or localized aortic dissection underwent aortic root surgery: 62 patients (3.6 ± 2.9 EuroSCORE II, 73% males, 58 ± 11 years) were operated via a J-shaped PUS. 32 patients (5.3 ± 5.4 EuroSCORE II, 59% males, 65 ± 10 years) underwent the same procedures via FMS. In the PUS-group, 49 received a Bentall- and 13 a David-procedure. In the FMS-group were 25 Bentall- and 7 David-procedures. Primary endpoints were mortality, MACCE and aortic re-intervention in a two-year follow-up. Secondary endpoints were perioperative complications, hospitalization time, and patient's satisfaction.

Result: There were no differences between mean operation-times (286 ± 61 vs. 293 ± 67 minutes, p = 0.76), cardiopulmonary bypass (176 ± 51 vs. 179 ± 53 minutes, p = 0.79), and cross-clamp times (135 ± 32 vs. 131 ± 34 minutes, p = 0.71) between PUS and FMS. Postoperative bleeding (534 ± 300 vs. 755 ± 403 mL, p = 0.01), erythrocytes substitution (3 ± 3 vs. 5.3 ± 4.9, p = 0.018), and pneumonia rates (0 vs. 9.4%, p = 0.04) were lower and the hospitalization period shorter (11.5 ± 4.5 vs. 14.3 ± 5.8 days, p = 1.12) in the PUS group. 30-day mortality and MACCE rates were 0%. In the 2-year follow-up, the mortality (0 vs. 6.7%, p = 0.11) and the MACCE rates (3.4 vs. 6.7%, p = 0.41) were lower in the PUS group. Aortic reinterventions were needed in 6 (10%) PUS and 3(11.5%) FMS patients. 86% PUS vs. 80% FMS patients were satisfied with the operative result.

Conclusion: Minimally invasive surgery of aortic root through PUS is a safe alternative to the conventional FMS, offering less trauma, a shorter recovery, and excellent midterm results.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021