Minimally Invasive Aortic Root Replacement is Safe: Results of First Fifty Patients

Objectives: Even though minimally access Cardiac Surgery may reduce morbidity, this approach is seldom used, especially for aortic root surgery. The purpose of this study was to assess aortic root replacement via an upper mini-sternotomy.

Methods: Between 4/2011 and 6/2014, fifty patients underwent elective minimally access aortic root replacement. Twenty-four patients (20 male, age 54.9 ± 11.9 years) underwent Bentall and twenty-six patients (22 male, age 47.6 ± 13 years) David procedure, respectively. 42.3% (11/26) patients underwent additional leaflet repair in David group. There was no intra-operative conversion to valve replacement in David group.

In the Bentall group, 79.2% (19/24) received Biological valved conduit and 20.8% (5/24) received mechanical valved conduit, respectively. Only the patients with pathological aortic valve underwent Bentall procedures.

Concomitant procedures were: 2 proximal arch replacements and one CABG in Bentall group and three proximal arch replacements and one CABG in David group.

Results: There was no 30 day mortality. X-clamp and Cardio-pulmonary bypass times were 108.9 ± 41 minute and 176.5 ± 71.9 minutes in Bentall patients, and 115.6 ± 30.3 minute, 175.8 ± 41.9 minutes in David patients, respectively. There was no intra-operative conversion to full sternotomy in either group.

Peri-operitaively, blood transfusion was 1.4 ± 1.7 packs in Bentall group and 1 ± 1.7 packs in David group, respectively.

Two patients were re-opened (via same access) due to post-operative bleeding in Bentall group and five patients in David group, respectively. The post-operative ventilation time was 12.9 ± 10.3 hour (Bentall) and 11.8 ± 6 hour (David), respectively. Both peri-operative stroke and 30 day mortality were 0% in both the groups.

The mean hospital stay was 11.1 ± 4.4 days (Bentall) and 10.4 ± 6.8 days (David), respectively.

The patient questionnaire showed that the convalescence time (time needed to get back to normal activities) was approx. 2 weeks.

Fig. 1 David.foto.

Conclusions: Our results show that minimally access aortic root replacement can be safely performed. The key to success is a step by step technique of moving from minimally access aortic valve replacement to more demanding aortic root replacements. Meticulous hemostasis & attention to surgical details is of utmost importance to prevent peri-operative complications. Such surgery can be routinely performed in selected elective patients.