Minimally Invasive Replacement of Ascending Aortic Aneurysms: Intermediate Term Results

Abstract

Background: Minimally invasive techniques have gained recent interest in the realm of cardiac surgery. This report describes our initial experience with graft replacement of ascending aortic aneurysms using a superior mini-sternotomy approach.

Methods: Between March 1997 and October 1997, four patients underwent operation for ascending aortic aneurysm via superior mini-sternotomy approach. There were two female and two male patients, ranging in age from 52 to 62 years (mean 53.7 ± 7.6). All patients had the stigmata of Marfan’s syndrome. Mean diameter of the ascending aortas was 6.1 ± 0.9 cm. Composite graft replacement with coronary reimplantation was performed in all cases. In one patient hemiarch replacement was performed under total circulatory arrest. There was no hospital (30-day) mortality. Mean aortic cross clamp and cardiopulmonary bypass times were 63 ± 14.1 minutes (range 44 to 78) and 116.7 ± 43.3 minutes (range 81 to 177), respectively. One patient was reexplored for bleeding.

Results: Lengths of hospital stay ranged from 5 to 7 days (mean 5.5 ± 1). Patients were followed-up for at least 18 months. One patient suffered a fatal stroke in her third postoperative month. All surviving patients were in NYHA Class I at the sixth postoperative month and thereafter.

Conclusions: Minimally invasive graft replacement of ascending aortic aneurysms can be performed safely and effectively. Long term results are likely to be similar to those of conventional cases performed through a full median sternotomy.