Minimally Invasive Approach in Aortic Surgery: from Root to Aortic Arch

Methods: 105 patients underwent surgical treatment through mini-sternotomy in Jan.2015-Nov.2017 in Aortic Surgery Department. In most of the cases surgery was performed through J-shaped mini-sternotomy in IV intercostal space, only in several patients – through T-sternotomy and J-sternotomy through III intercostal space. Mean age of the patientswas 56,4±11,4 years (72,7% male). Mean body mass index was 2,1. In all of the group of the patients 63 underwernt Bentall procedure or ascending aortic and aortic valve replacement. Valve-sparing interventions were performed in 31 cases, isolated ascending aortic replacement – in 9 and other types of surgery – in 2 patients. Aortic arch replacement was performed in 11 cases, hybrid surgery – in 5 patients. Concomitant mitral valve reconstruction was performed in 10 patients. In all cases peripheral cardiopulmonary bypass (CPB) was performed.

Results: In-hospital mortality was 1,9%. Conversion to full sternotomy was performed in 2 cases. Mean duration of CPB in Bentall procedures was 96,6±18min and in David procedure - 138±10min; Duration of aortic cross-clamping –72,2±5 min and 117±6 min respectively. Mean intraoperative blood loss was 750 ±143 ml and 758±156 ml after Bentall-DeBono and David procedures respectively. Intensive care unit stay in all of the cases was no longer than 24 hours. In all of the the cases there was no wound infection observed. Mean in-hospital stay was 7,5±1 days. Among nonlethal complications there was pulmonary failure (observed in 14 cases), arrythmia (in 20 patients) and lymphorrhea (in 10 cases).

Conclusions: J-mini-sternotomy provides fully functional access to aortic root, ascending aorta and its arch. This method is associated with smooth postoperative period, low rate of pulmonary complications and reduced rate of wound infections.