Upper hemisternotomy for supracoronary ascending aorta and aortic valve replacement significantly reduced median ventilation time compared to full sternotomy (7 vs 17 hours; P=0.005).
Cohort (n=100)
No
Does upper hemisternotomy improve perioperative outcomes compared to full sternotomy in patients undergoing replacement of the supracoronary ascending aorta and aortic valve?
Upper hemisternotomy is a safe alternative to full sternotomy for ascending aorta and aortic valve replacement, potentially offering faster respiratory recovery.
Absolute Event Rate: 7% vs 17%
p-value: p=0.005
Objective: Upper hemisternotomy (UHS) for supracoronary ascending aorta replacement (scAAR) with concomitant aortic valve replacement (AVR) results in less trauma and potentially faster convalescence compared with full sternotomy (FS). Direct head-to-head studies are lacking. We compared a group of UHS patients with a matched group of FS patients undergoing scAAR and AVR. Methods: There were 198 patients who underwent scAAR and AVR procedures by a single surgeon between 1999 and 2020. After matching 6 preoperative characteristics, there were 50 UHS and 50 FS patients. Patients who required acute type A aortic dissection repair, reoperations, concomitant procedures, or hypothermic circulatory arrest were excluded. Results: In the matched sample, the hospital mortality rate was 1% (1 of 100). The median cardiopulmonary bypass time was 150 (interquartile range IQR, 131 to 172) min and 164.5 (IQR, 138 to 190) min, respectively, for the UHS and FS groups ( P = 0.08). The median aortic cross-clamp time was 121 (IQR, 107 to 139) min during UHS and 131 (IQR, 115 to 159) min during FS ( P = 0.05). The median ventilation time was 7 (IQR, 3 to 14) h versus 17 (IQR, 10 to 24) h, respectively, after UHS and FS ( P = 0.005). The median hospital length of stay was 7 (IQR, 6 to 9) days after UHS and 8 (IQR, 7 to 11) days after FS ( P = 0.05). Conclusions: The low morbidity and mortality support the wider use of UHS for scAAR and AVR in appropriately selected patients. Larger studies are needed to confirm these initial findings.
Shah et al. (Tue,) conducted a cohort in Supracoronary ascending aorta replacement and aortic valve replacement (n=100). Upper hemisternotomy vs. Full sternotomy was evaluated on Median ventilation time (hours) (p=0.005). Upper hemisternotomy for supracoronary ascending aorta and aortic valve replacement significantly reduced median ventilation time compared to full sternotomy (7 vs 17 hours; P=0.005).