Minimally Invasive Aortic Root Surgery: Mid-Term Results in a 2-Year Follow-Up

Elghannam M*, Aljabery Y, Useini D, Naraghi H, Moustafine V, Bechtel M, Strauch J and Haldenwang P

Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Germany

^*Correspondance to: Elghannam M 

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Abstract:

Objectives: Minimally Invasive Surgery (MIS) through Partial Upper Sternotomy (PUS) for
aortic root surgery represents an alternative to the Full Median Sternotomy (FMS). PUS offers less
operative trauma which improves the postoperative outcome. Nevertheless, the PUS requires a
demanding surgical technique, with longer operation times, offering a reduced surgical field.
We analyzed the mid-term outcome of our patients who underwent either root replacement
(Bentall) or aortic root sparing valve reconstruction (David) via PUS to evaluate the safety of this
access.
Methods: Between 11/2011-04/2017, a total of 47 consecutive patients underwent aortic root surgery
with aortic aneurysm and/or localized aortic dissection through Bentall or David operation through
a J-shaped PUS (33 males, 14 females, and mean Age 57.9 ± 10.5 years). Bentall operation was
performed in 36 patients (77%), whereas 11 patients (23%) received a David procedure. Endpoints
were procedure related complications, the 30-day and 2-year mortality, the need for re-do surgery
and occurrence of MACCE in a 2-year follow-up. Postoperative patient’s contentment analysis was
performed using a questionnaire regarding the post-operative life quality, the satisfaction with the
cosmetic result and the approach preference (PUS vs. FUS) for a potential following aortic surgery.
Results: In all patients a J-shaped sternotomy was applied. Respectively, mean operation time was
287.3 ± 72.6 minutes, mean cardiopulmonary bypass (CPB) time 174 ± 54.8 min, mean cross-clamp
time 133 ± 33.1 min. Re-thoracotomy due to postoperative bleeding was needed in six patients
(13%). Superficial wound healing disturbance was observed in one patient (8%) and no deep sternal
infection or sternum instability occurred. Hospitalization time was 11.8 ± 4.4 days, mean ICU-stay
1.9 ± 1.3 days with a ventilation-time of 11.3 ± 5.8 h. During the first 30 postoperative days no
MACCE occurred and the mortality rate was 0%. After 2 years the total rate of Mortality, occurrence
of MACCE, and need for re-do surgery was as follow (6.3%, 4.2%, and 4.2%). 6 month after surgery
67% of the patients declared to have a better life quality and performance, 93% to be satisfied with
the cosmetic result and 92% stated that they would prefer the PUS for a potential future aortic
surgery.
Conclusion: Minimally invasive surgery of aortic root through partial upper sternotomy is a safe
alternative to the full median sternotomy. Although it requires longer operative times, it offers-due
to the diminished trauma-a reduced postoperative morbidity with a fast postoperative recovery and
good postoperative outcome.

Keywords:

Minimally invasive surgery; Aortic root surgery; Bentall operation; David operation; Partial upper sternotomy

Cite the Article:

Elghannam M, Aljabery Y, Useini D, Naraghi H, Moustafine V, Bechtel M, et al. Minimally Invasive Aortic Root Surgery: Mid-Term Results in a 2-Year Follow-Up. World J Surg Surgical Res. 2019; 2: 1173..