Minimally Invasive Approach for Replacement of the Ascending Aorta towards the Proximal Aortic Arch
Abstract
:1. Introduction
2. Patients and Methods
2.1. Patients
2.2. Study Design and Variables
2.3. Surgical Techniques
2.4. Statistical Analysis
3. Results
4. Discussion
5. Limitations and Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Dieberg, G.; Smart, N.A.; King, N. Minimally invasive cardiac surgery: A systematic review and meta-analysis. Int. J. Cardiol. 2016, 223, 554–560. [Google Scholar] [CrossRef] [PubMed]
- Claessens, J.; Rottiers, R.; Vandenbrande, J.; Gruyters, I.; Yilmaz, A.; Kaya, A.; Stessel, B. Quality of life in patients undergoing minimally invasive cardiac surgery: A systematic review. Indian J. Thorac. Cardiovasc. Surg. 2023, 39, 367–380. [Google Scholar] [CrossRef] [PubMed]
- Helms, F.; Schmack, B.; Weymann, A.; Hanke, J.S.; Natanov, R.; Martens, A.; Ruhparwar, A.; Popov, A.-F. Expanding the Minimally Invasive Approach towards the Ascending Aorta-A Practical Overview of the Currently Available Techniques. Medicina 2023, 59, 1618. [Google Scholar] [CrossRef] [PubMed]
- Jahangiri, M.; Hussain, A.; Akowuah, E. Minimally invasive surgical aortic valve replacement. Heart 2019, 105 (Suppl. 2), s5–s10. [Google Scholar] [CrossRef] [PubMed]
- Monsefi, N.; Risteski, P.; Miskovic, A.; Moritz, A.; Zierer, A. Midterm Results of a Minimally Invasive Approach in David Procedure. Thorac. Cardiovasc. Surg. 2018, 66, 301–306. [Google Scholar] [CrossRef] [PubMed]
- Sun, L.; Zheng, J.; Chang, Q.; Tang, Y.; Feng, J.; Sun, X.; Zhu, X. Aortic root replacement by ministernotomy: Technique and potential benefit. Ann. Thorac. Surg. 2000, 70, 1958–1961. [Google Scholar] [CrossRef] [PubMed]
- Shrestha, M.; Kaufeld, T.; Shrestha, P.; Martens, A.; Rustum, S.; Rudolph, L.; Krüger, H.; Arar, M.; Haverich, A.; Beckmann, E. Valve-sparing David procedure via minimally invasive access does not compromise outcome. Front. Cardiovasc. Med. 2022, 9, 966126. [Google Scholar] [CrossRef] [PubMed]
- Haunschild, J.; van Kampen, A.; von Aspern, K.; Misfeld, M.; Davierwala, P.; Saeed, D.; Borger, M.A.; Etz, C.D. Supracommissural replacement of the ascending aorta and the aortic valve via partial versus full sternotomy-a propensity-matched comparison in a high-volume centre. Eur. J. Cardiothorac. Surg. 2022, 61, 479–487. [Google Scholar] [CrossRef] [PubMed]
- Lamelas, J.; Chen, P.C.; Loor, G.; LaPietra, A. Successful Use of Sternal-Sparing Minimally Invasive Surgery for Proximal Ascending Aortic Pathology. Ann. Thorac. Surg. 2018, 106, 742–748. [Google Scholar] [CrossRef] [PubMed]
- LaPietra, A.; Santana, O.; Pineda, A.M.; Mihos, C.G.; Lamelas, J. Outcomes of aortic valve and concomitant ascending aorta replacement performed via a minimally invasive right thoracotomy approach. Innovations 2014, 9, 339–342, discussion 342. [Google Scholar] [PubMed]
- Kaneko, T.; Couper, G.S.; Borstlap, W.A.A.; Nauta, F.J.H.; Wollersheim, L.; McGurk, S.; Cohn, L.H. Minimal-access aortic valve replacement with concomitant aortic procedure: A 9-year experience. Innovations 2012, 7, 368–371. [Google Scholar] [PubMed]
- Tabata, M.; Khalpey, Z.; Aranki, S.F.; Couper, G.S.; Cohn, L.H.; Shekar, P.S. Minimal access surgery of ascending and proximal arch of the aorta: A 9-year experience. Ann. Thorac. Surg. 2007, 84, 67–72. [Google Scholar] [CrossRef] [PubMed]
- Svensson, L.G.; Nadolny, E.M.; Kimmel, W.A. Minimal access aortic surgery including re-operations. Eur. J. Cardiothorac. Surg. 2001, 19, 30–33. [Google Scholar] [CrossRef] [PubMed]
- Byrne, J.G.; Karavas, A.N.; Cohn, L.H.; Adams, D.H. Minimal access aortic root, valve, and complex ascending aortic surgery. Curr. Cardiol. Rep. 2000, 2, 549–557. [Google Scholar] [CrossRef] [PubMed]
- Angerer, M.; Pollari, F.; Hitzl, W.; Weber, L.; Sirch, J.; Fischlein, T. Isolated or Combined Ascending Aortic Replacement through a Partial Sternotomy: Early and Midterm Outcomes. Thorac. Cardiovasc. Surg. 2024, 4–16, ahead of print. [Google Scholar]
- Deschka, H.; Erler, S.; Machner, M.; El-Ayoubi, L.; Alken, A.; Wimmer-Greinecker, G. 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. 2013, 43, 580–584. [Google Scholar] [CrossRef] [PubMed]
- El-Hamamsy, I.; Ouzounian, M.; Demers, P.; McClure, S.; Hassan, A.; Dagenais, F.; Chu, M.W.; Pozeg, Z.; Bozinovski, J.; Peterson, M.D.; et al. State-of-the-Art Surgical Management of Acute Type A Aortic Dissection. Can. J. Cardiol. 2016, 32, 100–109. [Google Scholar] [CrossRef] [PubMed]
- Webster, A.C.; Nagler, E.V.; Morton, R.L.; Masson, P. Chronic Kidney Disease. Lancet 2017, 389, 1238–1252. [Google Scholar] [CrossRef] [PubMed]
- Hynes, C.F.; Greenberg, M.D.; Sarin, S.; Trachiotis, G.D. Chronic Type A Aortic Dissection. Aorta 2016, 4, 16–21. [Google Scholar] [CrossRef] [PubMed]
- Staromłyński, J.; Kowalewski, M.; Sarnowski, W.; Smoczyński, R.; Witkowska, A.; Bartczak, M.; Drobiński, D.; Wierzba, W.; Suwalski, P. Midterm results of less invasive approach to ascending aorta and aortic root surgery. J. Thorac. Dis. 2020, 12, 6446–6457. [Google Scholar] [CrossRef] [PubMed]
- Wu, Y.; Jiang, W.; Li, D.; Chen, L.; Ye, W.; Ren, C.; Xiao, C. Surgery of ascending aorta with complex procedures for aortic dissection through upper mini-sternotomy versus conventional sternotomy. J. Cardiothorac. Surg. 2020, 15, 57. [Google Scholar] [CrossRef] [PubMed]
Characteristics | Ascending Aorta Replacement (n = 46) | Proximal Aortic Arch Replacement (n = 40) | p-Value |
---|---|---|---|
Sex (male) | 22 (47.8%) | 14 (35.0%) | 0.229 |
Age (years) | 64.5 (53.5–74.4) | 69.0 (64.4–75.4) | 0.029 |
Coronary artery disease | 6 (13.0%) | 14 (35.0%) | 0.016 |
Atrial fibrillation | 5 (10.9%) | 4 (10.0%) | 0.895 |
Pulmonary artery embolism | 3 (6.5%) | 1 (2.5%) | 0.337 |
Persistent foramen ovale | 2 (4.3%) | 0 (0.0%) | 0.182 |
Preoperative stroke | 1 (2.2%) | 3 (7.5%) | 0.242 |
Diabetes | 2 (4.3%) | 2 (5.0%) | 0.886 |
Chonic kidney disease | 1 (2.2%) | 3 (7.5%) | 0.242 |
COPD | 4 (8.7%) | 4 (10.0%) | 0.835 |
Bicuspid aortic valve | 11 (23.5%) | 3 (7.5%) | 0.040 |
Aortitis | 2 (4.3%) | 1 (2.5%) | 0.641 |
Chronic aortic dissection | 0 (0.0%) | 1 (2.5%) | 0.281 |
Penetrating aortic ulcer | 0 (0.0%) | 1 (2.5%) | 0.281 |
Cardiac preoperation | 0 (0.0%) | 1 (2.5%) | 0.281 |
Characteristics | Ascending Aorta Replacement (n = 46) | Proximal Aortic Arch Replacement (n = 40) | p-Value |
---|---|---|---|
Concomitant cardiac procedure | 3 (6.5%) | 2 (5.0%) | 0.764 |
Graft size (mm) | 28 (26–30) | 30 (28–30) | 0.130 |
Operation time (min) | 168 (143–204) | 223 (207–243) | <0.001 |
Bypass time (min) | 77 (65–102) | 123 (104–139) | <0.001 |
Cross-clamp time (min) | 47 (39–57) | 51 (40–67) | 0.301 |
Conversion to full sternotomy | 0 (0.0%) | 1 (2.5%) | 0.281 |
Characteristics | Ascending Aorta Replacement (n = 46) | Proximal Aortic Arch Replacement (n = 40) | p-Value |
---|---|---|---|
Ventilation time (hours) | 10.3 ± 4.8 | 20.4 ± 7.0 | 0.009 |
ICU stay (days) | 2.02 ± 2.1 | 2.83 ± 2.8 | 0.134 |
Hospital stay (days) | 8 (7–11) | 10 (8–13) | 0.111 |
Reanimation (ventricular fibrillation) | 1 (2.2%) | 2 (5.0%) | 0.476 |
Delirium | 0 (0.0%) | 2 (5.0%) | 0.125 |
Atrial fibrillation | 6 (13.0%) | 5 (12.5%) | 0.940 |
Re-thoracotomy | 0 (0.0%) | 2 (5.0%) | 0.125 |
Tracheotomy | 0 (0.0%) | 1 (2.5%) | 0.281 |
Stroke | 1 (2.2%) | 3 (7.5%) | 0.242 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Helms, F.; Deniz, E.; Krüger, H.; Zubarevich, A.; Schmitto, J.D.; Poyanmehr, R.; Hinteregger, M.; Martens, A.; Weymann, A.; Ruhparwar, A.; et al. Minimally Invasive Approach for Replacement of the Ascending Aorta towards the Proximal Aortic Arch. J. Clin. Med. 2024, 13, 3274. https://doi.org/10.3390/jcm13113274
Helms F, Deniz E, Krüger H, Zubarevich A, Schmitto JD, Poyanmehr R, Hinteregger M, Martens A, Weymann A, Ruhparwar A, et al. Minimally Invasive Approach for Replacement of the Ascending Aorta towards the Proximal Aortic Arch. Journal of Clinical Medicine. 2024; 13(11):3274. https://doi.org/10.3390/jcm13113274
Chicago/Turabian StyleHelms, Florian, Ezin Deniz, Heike Krüger, Alina Zubarevich, Jan Dieter Schmitto, Reza Poyanmehr, Martin Hinteregger, Andreas Martens, Alexander Weymann, Arjang Ruhparwar, and et al. 2024. "Minimally Invasive Approach for Replacement of the Ascending Aorta towards the Proximal Aortic Arch" Journal of Clinical Medicine 13, no. 11: 3274. https://doi.org/10.3390/jcm13113274
APA StyleHelms, F., Deniz, E., Krüger, H., Zubarevich, A., Schmitto, J. D., Poyanmehr, R., Hinteregger, M., Martens, A., Weymann, A., Ruhparwar, A., Schmack, B., & Popov, A.-F. (2024). Minimally Invasive Approach for Replacement of the Ascending Aorta towards the Proximal Aortic Arch. Journal of Clinical Medicine, 13(11), 3274. https://doi.org/10.3390/jcm13113274