Proximal Aortic Surgery: Upper “J” or Conventional Sternotomy?

Authors

  • İsmail Oral Hastaoglu Department of Cardiovascular Surgery, Erdem Hospital- Cakmak, Alemdag Caddesi, Istanbul, Turkey
  • Hamdi Tokoz Department of Cardiovascular Surgery, Erdem Hospital- Cakmak, Alemdag Caddesi, Istanbul, Turkey
  • Ayca Ozgen Department of Cardiovascular Surgery, Erdem Hospital-Acibadem, Alemdag Caddesi, Istanbul, Turkey
  • Fuat Bilgen Department of Cardiovascular Surgery, Erdem Hospital- Cakmak, Alemdag Caddesi, Istanbul, Turkey

DOI:

https://doi.org/10.1532/hsf.1649

Abstract

Background: While minimally invasive procedures are being used in cardiac surgery, experience with minimally invasive proximal aortic surgery has been limited to certain centers.

Methods: Between January 2010 and March 2015,
54 patients with an upper “J” hemi-sternotomy and 75 patients with a conventional sternotomy due to proximal aortic pathology were included in this study. Forty-five patients from the “J” hemi-sternotomy group were matched with 45 patients from the conventional sternotomy group with respect to age, sex, ejection fraction, diabetes, hypertension, smoking history and operative type. Perioperative variables were in-hospital mortality, surgery for revision, amount of blood loss, requirement for blood transfusion, cardiopulmonary bypass (CPB), aortic cross-clamp and unilateral cerebral protection times, duration of ventilation, and length of intensive care unit (ICU) and total hospital stay.

Results: Patients were between 21-76 years with a mean age of 58.14 ± 11.06 years; 73.3% (n = 66) were male and 26.7% (n = 24) were female. Of all the cases included, 36.7% (n = 33) had isolated ascending aortic replacement, 41.1%
(n = 37) had concomitant aortic valve replacement and ascending aortic replacement, and 22.2% (n = 20) had a Bentall procedure. Statistically, the amount of bleeding (P = .026), length of ventilation (P = .001), ICU (P = .001) and total hospital stay (P = .004) in the “J” hemi-sternotomy group were all found to be significantly lower than those in the conventional group.

Conclusions: Minimally invasive techniques like an upper “J” hemi-sternotomy can be safely performed without prolonging the aortic clamp time, and with less blood loss, less ventilatory support, and shorter ICU and total hospital stays when compared to conventional methods.

References

Aris A, Camara ML, Montiel J, et al. 1999. Ministernotomy versus median sternotomy for aortic replacement: A prospective, randomized study. Ann Thorac Surg 67:1583-1587; discussion 1587-1588.

Bakir I, Casselman FP, Wellens F, et al. 2006. Minimally invasive versus standard approach aortic valve replacement: a study in 506 patients. Ann Thorac Surg 81:1599-1604.

Bonacchi M, Prifti E, Giunti G, Frati G, Sani G. 2002. Does ministernotomy improve postoperative outcome in aortic valve operation? A prospective randomized study. Ann Thorac Surg 73:460-465; discussion 465-466.

Borger MA, Moustafine V, Conradi L, et al. 2015. A randomized multicenter trial of minimally invasive rapid deployment versus conventional full sternotomy aortic valve replacement. Ann Thorac Surg 99:17-25.

Cosgrove MD 3rd, Sabik JF. 1996. Minimaly invasive approach for aortic valve operations. Ann Thorac Surg 62:596-597.

Deschka H, Erler S, Machner M, et al. 2013. Surgery of the ascending aorta, root remodelling and aortic arch surgery with circulatory arrest through partial upper sternotomy: results of 50 consecutive cases. Eur J Cardiothorac Surg 43:580-584.

Gilmanov D, Solinas M, Farneti PA, et al. 2015. Minimally invasive aortic valve replacement: 12-year single center experience. Ann Cardiothorac Surg 4:160-169.

Machler HE, Bergmann P, Anelli-Monti M, et al. 1999. Minimaly invasive versus conventional aortic valve operations: A prospective study in 120 patients. Ann Thorac Surg 67:1001-1005.

Mihaljevic T, Cohn LH, Unic D, et al. 2004. One thousand minimally invasive valve operations: early and late results. Ann Surg 240:529-534; discussion 534.

Navia JL, Cosgrove DM 3rd. Minimally invasive mitral valve operations. 1996. Ann Thorac Surg 62:1542-1544.

Phan K, Xie A, Di Eusanio M, Yan TD. 2014. A meta-analysis of minimally invasive versus conventional sternotomy for aortic valve replacement. Ann Thorac Surg 98:1499-1511.

Phan K, Xie A, Tsai YC, et al. 2015. Ministernotomy or minithoracotomy for minimally invasive aortic valve replacement: a Bayesian network meta-analysis. Ann Cardiothorac Surg 4:3-14.

Shehada SE, Öztürk Ö, Wottke M, Lange R. 2016. Propensity score analysis of outcomes following minimal access versus conventional aortic valve replacement. Eur J Cardiothorac Surg 49:464-469.

Semsroth S, Matteucci-Gothe, Heinz A, et al. 2015. Comparison of anterolateral minithoracotomy versus partial upper hemisternotomy in aortic valve replacement. Ann Thorac Surg 100:868-873.

Svensson LG, Nadolny EM, Kimmel WA. 2001. Minimal access aortic surgery including re-operations. Eur J Cardiothorac Surg 19:30-33.

Tabata M, Khalpey Z, Aranki SF, et al. 2007. Minimal access surgery of ascending and proximal arch of the aorta: a 9-year experience. Ann Thorac Surg 84:67-72.

Published

2018-01-05

How to Cite

Hastaoglu, İsmail O., Tokoz, H., Ozgen, A., & Bilgen, F. (2018). Proximal Aortic Surgery: Upper “J” or Conventional Sternotomy?. The Heart Surgery Forum, 21(1), E004-E008. https://doi.org/10.1532/hsf.1649

Issue

Section

Article