Ministernotomy in Aortic Root and Arch Surgery: Early Outcomes

Kulacoglu, Ulku Kafa; Kaya, Mehmet

doi:10.21470/1678-9741-2021-0372

Cited by 3 publications

(1 citation statement)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, up to 25% of aortic patients fall into the frailty definition ( 104 ). Also in this case, less invasive approaches through mini-sternotomy ( 105 ) and beating heart techniques to reduce the myocardial ischemic time ( 106 ) have been described. Besides the open repair techniques, hybrid arch repair combining vascular and endovascular treatment has gained popularity ( 107 ).…”

Section: Intraoperative Choices For Frail Patients: the Right Strateg...mentioning

confidence: 99%

The frail patient undergoing cardiac surgery: lessons learned and future perspectives

Pozzi,

Mariani,

Scanziani

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Frailty is a geriatric condition characterized by the reduction of the individual's homeostatic reserves. It determines an increased vulnerability to endogenous and exogenous stressors and can lead to poor outcomes. It is an emerging concept in perioperative medicine, since an increasing number of patients undergoing surgical interventions are older and the traditional models of care seem to be inadequate to satisfy these patients' emerging clinical needs. Nowadays, the progressive technical and clinical improvements allow to offer cardiac operations to an older, sicker and frail population. For these reasons, a multidisciplinary team involving cardiac surgeons, clinical cardiologists, anesthesiologists, and geriatricians, is often needed to assess, select and provide tailored care to these high-risk frail patients to optimize clinical outcomes. There is unanimous agreement that frailty assessment may capture the individual's biological decline and the heterogeneity in risk profile for poor health-related outcomes among people of the same age. However, since commonly used preoperative scores for cardiac surgery fail to capture frailty, a specific preoperative assessment with dedicated tools is warranted to correctly recognize, measure and quantify frailty in these patients. On the contrary, pre-operative and post-operative interventions can reduce the risk of complications and support patient recovery promoting surgical resilience. Minimally invasive cardiac procedures aim to reduce surgical trauma and may be associated with better clinical outcome in this specific sub-group of high-risk patients. Among postoperative adverse events, the occurrence of delirium represents a risk factor for several unfavorable outcomes including mortality and subsequent cognitive decline. Its presence should be carefully recognized, triggering an adequate, evidence based, treatment. There is evidence, from several cross-section and longitudinal studies, that frailty and delirium may frequently overlap, with frailty serving both as a predisposing factor and as an outcome of delirium and delirium being a marker of a latent condition of frailty. In conclusion, frail patients are at increased risk to experience poor outcome after cardiac surgery. A multidisciplinary approach aimed to recognize more vulnerable individuals, optimize pre-operative conditions, reduce surgical invasivity and improve post-operative recovery is required to obtain optimal long-term outcome.

show abstract

Section: Intraoperative Choices For Frail Patients: the Right Strateg...mentioning

confidence: 99%

The frail patient undergoing cardiac surgery: lessons learned and future perspectives

Pozzi,

Mariani,

Scanziani

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

Minimal access aortic surgery

Osada,

Minatoya

2023

Indian J Thorac Cardiovasc Surg

View full text Add to dashboard Cite

Minimally invasive versus conventional methods for aortic root surgery: Choosing the right approach

Karadzha,

Sharifulin,

Khrushchev

et al. 2024

Asian Cardiovasc Thorac Ann

View full text Add to dashboard Cite

Objective Partial upper sternotomy is preferred for isolated aortic valve replacement because of its optimal surgical visibility and favorable cosmetic outcomes; however, it is not commonly used for aortic root surgery, and the conventional median sternotomy is still the preferred method for most surgeons. We aimed to compare the safety and effectiveness of a minimally invasive approach (partial sternotomy [PS]) and conventional approach (median sternotomy [FS]) for aortic root surgery. Methods Patients who underwent aortic root surgery at our hospital from 2016 to 2021 were retrospectively enrolled and divided into two groups. After propensity score matching, the conventional group included 156 patients and the minimally invasive group—57 patients. Results Bicuspid aortic valves were observed in 63 (40.4%) and 33 (57.9%) patients in the FS and PS groups, respectively. Valve-sparing surgery was performed on 69 (44.2%) and 30 (52.6%) patients in the FS and PS groups, respectively. The minimally invasive approach was beneficial in terms of blood loss during the first 24 h after surgery ( p = 0.029) and postoperative blood transfusion ( p = 0.023). The survival rates and freedom from reoperation or severe aortic regurgitation after the David procedure were comparable between the standard and minimally invasive groups ( p = 0.25; p = 0.66) at mid-term follow-up. Conclusions A minimally invasive approach for aortic root surgery can be safely performed as the standard approach. Partial upper sternotomy has the advantage of lower blood loss in the early postoperative period and does not negatively affect the results of valve-sparing root replacement.

show abstract

Ministernotomy in Aortic Root and Arch Surgery: Early Outcomes

Cited by 3 publications

References 18 publications

The frail patient undergoing cardiac surgery: lessons learned and future perspectives

The frail patient undergoing cardiac surgery: lessons learned and future perspectives

Minimal access aortic surgery

Minimally invasive versus conventional methods for aortic root surgery: Choosing the right approach

Contact Info

Product

Resources

About