Minimal Access Aortic Surgery via Ministernotomy: Efficacy and Outcome Assessment of a Single Centre Experience

Abdul Nasir ¹, Omar Nawaytou ², Debbie Harrington ², Mark Field ², Manoj Kuduvalli ², Aung Oo ³, Tristan Yan ⁴

¹ New Cross Hospital , Wolverhampton, United Kingdom; ² Liverpool Heart and Chest Hospital , Liverpool, United Kingdom; ³ St Bartholomews Hospital, London, United Kingdom; ⁴ Royal Prince Alfred Hospital, Sydney, Australia;

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – C

Abstract

Objective

Mini sternotomy incision has been used increasingly for aortic valve replacement and TAVI with favourable outcomes. Little, however, is published on its use in proximal aortic vascular surgery. The purpose of this study is to describe our experience with this technique for proximal aortic surgery.

Methods

Prospectively collected data was retrospectively reviewed for 33 patients undergoing proximal aortic surgery through mini sternotomy between October 2014 and April 2017.

Results

There were 25 males and the mean age was 67 years. One case had previous surgery. 32 patients underwent an upper hemisternotomy into the 3rd or 4th intercostal space and one patient had a lower hemisternotomy. Types of surgeries performed were AVR+Ascending (n=8), AVR+Hemiarch (n=3), Root Replacement (n=14), Root+Hemiarch (n=6), Total Arch and Frozen Elephant Trunk (n=2). In addition to the 2 arch replacements, 9 patients underwent deep hypothermic circulatory arrest (DHCA)and selective antegrade cerebral perfusion (SACP)for hemiarch replacement. There was one conversion to full sternotomy. Mean cardiopulmonary bypass, aortic cross clamp and circulatory arrest times were 219, 167 and 25 minutes. Mean total blood loss was 505mls and 1 re-exploration for bleeding. There were 2 episodes of retroperitoneal bleeding managed conservatively. Other post-operative complications included atrial fibrillation (n=8), stroke (n=1) and renal failure reqiring dialysis (n=1). Median length of stay was 10 days. There was one hospital mortality.

Conclusion

Mini sternotomy for proximal aortic vascular surgery including aortic arch replacement and FET under DHCA and SACP is applicable and safe. Early results are favourable with low complication rate. Our institutional results for mini sternotomy are comparable with full sternotomy cohort. Larger studies are needed to establish superiority over conventional sternotomy.