Minimally Invasive versus Conventional Aortic Root Surgery: Results of an Intermediate-Volume Center.

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Thoracic and Cardiovascular Surgeon Pub Date : 2024-03-01 Epub Date: 2023-02-23 DOI:10.1055/a-2041-3695

Mahmoud Elghannam, Dritan Useini, Vadim Moustafine, Matthias Bechtel, Hamid Naraghi, Justus T Strauch, Peter Lukas Haldenwang

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引用次数: 0

Abstract

Background: We evaluate the outcome of aortic root surgery via an upper J: -shaped mini-sternotomy (MS) versus full sternotomy (FS) in an intermediate-volume center.

Methods: Between November 2011 and February 2019, 94 consecutive patients underwent aortic root surgery: 62 (66%) patients were operated via a J: -shaped MS (group A) and 32 (34%) patients via FS (group B). The primary endpoints were mortality, major adverse cardiac and cerebral events (MACCE), and reoperation in a 2-year follow-up. The secondary endpoints were perioperative complications and patient's satisfaction with the procedural results.

Results: Valve sparing root replacement (David procedure) was performed in 13 (21%) of the MS and 7 (22%) of the FS patients. The Bentall procedure in MS versus FS was 49 (79%) versus 25 (78%), respectively. Both groups presented similar mean operation, cardiopulmonary bypass, and cross-clamp times. Postoperative bleeding was 534 ± 300 and 755 ± 402 mL (p = 0.01) in MS and FS, respectively, erythrocyte concentrate substitution was 3 ± 3 and 5.3 ± 4.8 (p = 0.018) in MS and FS, respectively, and pneumonia rates were 0 and 9.4% (p = 0.03) in MS and FS, respectively. The 30-day mortality was 0% in both groups, whereas MACCE was 1.6 and 3% (p = 0.45) in MS and FS, respectively. After 2 years, the mortality and MACCE were 4.6 and 9.5% (p = 0.11) and 4.6 and 0% (p = 0.66) in MS and FS, respectively. The number of patients who were satisfied with the surgical cosmetic results in groups A and B was 53 (85.4%) and 26 (81%), respectively.

Conclusion: Aortic root surgery via MS is a safe alternative to FS even in an intermediate-volume center. It offers a shorter recovery time and similar midterm results.

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微创与传统主动脉根部手术：一家中等规模中心的研究结果。

背景：我们在一家中等规模的医疗中心评估了通过上J：形小切口（MS）与全胸骨切开术（FS）进行主动脉根部手术的结果：2011年11月至2019年2月期间，94名患者连续接受了主动脉根部手术：62名患者（66%）通过J形MS手术（A组），32名患者（34%）通过FS手术（B组）。主要终点是死亡率、主要不良心脑事件（MACCE）和两年随访期间的再次手术。次要终点是围手术期并发症和患者对手术结果的满意度：13例（21%）MS患者和7例（22%）FS患者接受了疏通瓣膜根部置换术（David手术）。Bentall手术在MS和FS患者中的比例分别为49（79%）和25（78%）。两组的平均手术时间、心肺旁路时间和交叉钳夹时间相似。MS 和 FS 的术后出血量分别为 534 ± 300 mL 和 755 ± 402 mL（p = 0.01），红细胞浓缩物替代率分别为 3 ± 3 和 5.3 ± 4.8（p = 0.018），肺炎发生率分别为 0 和 9.4%（p = 0.03）。两组的 30 天死亡率均为 0%，而 MS 和 FS 的 MACCE 分别为 1.6% 和 3% (p = 0.45)。2 年后，MS 和 FS 的死亡率和 MACCE 分别为 4.6% 和 9.5% (p = 0.11) 以及 4.6% 和 0% (p = 0.66)。A组和B组对手术美容效果满意的患者人数分别为53人（85.4%）和26人（81%）：结论：通过 MS 进行主动脉根部手术是比 FS 更安全的选择，即使在一个中等规模的中心也是如此。结论：通过 MS 进行主动脉根部手术是一种安全的选择，即使在一个中等容量的中心也能替代 FS，而且恢复时间更短，中期效果相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Thoracic and Cardiovascular Surgeon 医学-呼吸系统

CiteScore

3.40

自引率

6.70%

发文量

365

审稿时长

3 months

期刊介绍： The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.