Successful Use of Sternal-Sparing Minimally Invasive Surgery for Proximal Ascending Aortic Pathology

Abstract

Background: A sternal-sparing approach to surgery of the proximal aorta could decrease postoperative morbidity.

Methods: To determine the potential benefits of using a minimally invasive right thoracotomy approach for the treatment of ascending aortic pathology, we retrospectively reviewed our experience in patients who required circulatory arrest for the treatment of ascending aortic pathology (with or without aortic valve involvement) between January 2009 and November 2014 (N = 177). We compared baseline characteristics, intraoperative characteristics, and postoperative clinical outcomes between those who underwent a sternotomy (n = 103) and those who underwent a minimally invasive right thoracotomy approach (n = 74). All surgical procedures were performed by a single surgeon. Propensity score matching was performed to account for baseline differences between groups.

Results: More patients in the minimally invasive group had bicuspid aortic valve, degenerative aortic valve, or aortic insufficiency than in the sternotomy group, but other baseline characteristics were similar between groups. No strokes occurred. In the unmatched cohort, 30-day mortality was 2.7% for the minimally invasive group compared with 1.9% for the sternotomy group (p = 1.00). In the propensity score-matched cohort, 30-day mortality was 3.2% for both groups; circulatory arrest times were longer in the minimally invasive group than in the sternotomy group (p < 0.0001), but the minimally invasive group had fewer red blood cell transfusions, shorter ventilation times, and shorter intensive care unit and hospital length of stay.

Conclusions: A sternal-sparing approach to surgery of the proximal aorta is safe when performed by an experienced surgeon and conserves hospital resources.