Key result
Minimally invasive aortic surgery achieves ~95% late survival at three years regardless of repair type.
Why the study?
Despite potential reductions in morbidity, minimally invasive approaches are not routinely performed for aortic surgery, prompting this evaluation of early and mid-term outcomes following minimally invasive aortic root and ascending aorta replacement.
Does minimally invasive aortic root and ascending aorta replacement provide safe early and mid-term outcomes in low- and intermediate-risk patients?
Cohort (n=167)
Does minimally invasive aortic root and ascending aorta replacement provide safe early and mid-term outcomes in low- and intermediate-risk patients?
Effect estimate: HR 0.81 (95% CI 0.36-1.81)
p-value: p=0.61
Minimally invasive aortic surgery via a 'V' shaped partial upper sternotomy is feasible and safe, demonstrating excellent mid-term survival (95%) in selected low- and intermediate-risk patients.
BACKGROUND: Minimally invasive aortic valve (AV) surgery has become widely accepted alternative to standard sternotomy. Despite possible reduction in morbidity, this approach is not routinely performed for aortic surgery. Current report aimed to demonstrate early and mid-term outcomes in patients undergoing minimally invasive aortic root- and ascending aorta-replacement with or without concomitant AV replacement (AVR). METHODS: Between 2011 and 2018, 167 selected low- and intermediate risk patients (mean age: 64.1±11.3; 70% men; EuroSCORE II 2.58±3.26) underwent minimally invasive aortic surgery. The "V" shaped partial upper sternotomy was performed through a 6-cm skin incision. Patients were divided into minimally invasive root reimplantation/replacement/remodelling (root RRR), supracoronary aorta replacements (SCAR) and SCAR+AVR. Kaplan-Meier estimates of survival were used. RESULTS: Mean follow-up was 3.1 year (max 7.7 years). Of 167 patients, 82 (49%) underwent SCAR; 44 (26%) SCAR + AVR. Forty-one patients (25%) underwent minimally invasive root RRR. Average aortic diameter was 6.00±0.46 cm. The cardiopulmonary bypass and aortic cross-clamp time were 152.0±46.8 and 101.8±36.8 minutes. There was one conversion to sternotomy. Median intensive care unit stay was 2.0 (IQR: 1.0-3.0) days. Thirty-day mortality was 1%. Within investigated follow-up, there was one late reoperation due to aortic valve thrombosis; late survival was estimated at 95% without differences between types of surgery: hazard ratio, 0.81; 95% CI: 0.36-1.81; P=0.61. CONCLUSIONS: Minimally invasive aortic surgery performed through "V" shaped partial upper sternotomy is feasible and safe in selected patients regardless of the extent of repair, from supracoronary aorta replacements to complex root surgery.
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Staromłyński et al. (2020) conducted a cohort in Aortic root and ascending aorta disease (n=167). Minimally invasive aortic surgery via 'V' shaped partial upper sternotomy was evaluated on Late survival (HR 0.81, 95% CI 0.36-1.81, p=0.61). Minimally invasive aortic surgery via partial upper sternotomy achieved 95% late survival at a mean 3.1 years, with no significant survival differences between types of aortic repair (HR 0.81; P=0.61).
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