Extensive repair of acute type A aortic dissection through a partial upper sternotomy and using complete stent-graft replacement of the arch

Xie, Xianbiao; Dai, Xiao-Fu; Fang, Guan-Hua; Qiu, Zhihuang; Jiang, Debin

doi:10.1016/j.jtcvs.2020.10.063

Cited by 10 publications

(10 citation statements)

References 18 publications

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“…Consistently, we found that both obese and non-obese patients in the PUS cohort exhibited shorter durations of hospitalization and ICU admittance as compared to patients in the FMS group. These findings are also consistent with previous meta-analyses [ 13 , 23 – 26 ]. We did not observe any differences in ICU or hospital stay length for obese patients in this study relative to non-obese patients in the PUS cohort, indicating that this MIS approach is not associated with any increased risk for obese individuals.…”

Section: Discussionsupporting

confidence: 93%

“…Patients in the present study that underwent treatment via a PUS approach exhibited reduced transfusion requirements as compared to patients treated via an FMS approach irrespective of whether or not they were obese. These results are in line with those of Wu et al [ 31 ] and Xie et al [ 13 , 20 , 32 , 33 ]. Previous evidence suggests that transfusions are associated with a negative impact on patient outcomes following cardiac surgery [ 34 – 37 ].…”

Section: Discussionsupporting

confidence: 93%

“…However, FMS remains the standard approach for complex aortic surgery to ensure appropriate exposure and safety [ 6 ]. Even so, recent studies have explored minimally invasive surgical approaches to accessing the aortic root [ 7 – 9 ], ascending aorta [ 10 ], or aortic arch [ 3 , 11 – 13 ]. These authors have reported successful surgical outcomes without increasing mortality or major complications.…”

Section: Introductionmentioning

confidence: 99%

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Surgical outcomes associated with partial upper sternotomy in obese aortic disease patients

Luo

Chen

2022

J Cardiothorac Surg

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Background Excellent partial upper sternotomy outcomes have been reported for patients undergoing aortic surgery, but whether this approach is particularly beneficial to obese patients remains to be established. This study was developed to explore the outcomes of aortic surgical procedures conducted via a partial upper sternotomy or a full median sternotomy approach in obese patients. Methods We retrospectively examined consecutive acute type A aortic dissection patients who underwent aortic surgery in our hospital between January 2015 to January 2021. Patients were divided into two groups based on body mass index: ‘non-obese’ and ‘obese’. We then further stratified patients in the obese and non-obese groups into partial upper sternotomy and full median sternotomy groups, with outcomes between these two sternotomy groups then being compared within and between these two body mass index groups. Results In total, records for 493 patients that had undergone aortic surgery were retrospectively reviewed, leading to the identification of 158 consecutive obese patients and 335 non-obese patients. Overall, 88 and 70 obese patients underwent full median sternotomy and partial upper sternotomy, respectively, while 180 and 155 non-obese patients underwent these respective procedures. There were no differences between the full median sternotomy and partial upper sternotomy groups within either BMI cohort with respect to preoperative baseline indicators and postoperative complications. Among non-obese individuals, the partial upper sternotomy approach was associated with reduced ventilation time (P = 0.003), shorter intensive care unit stay (P = 0.017), shorter duration of hospitalization (P = 0.001), and decreased transfusion requirements (Packed red blood cells: P < 0.001; Fresh frozen plasma: P < 0.001). Comparable findings were also evident among obese patients. Conclusions Obese aortic disease patients exhibited beneficial outcomes similar to those achieved for non-obese patients via a partial upper sternotomy approach which was associated with significant reductions in the duration of intensive care unit residency, duration of hospitalization, ventilator use, and transfusion requirements. This surgical approach should thus be offered to aortic disease patients irrespective of their body mass index.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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Surgical outcomes associated with partial upper sternotomy in obese aortic disease patients

Luo

Chen

2022

J Cardiothorac Surg

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“…Minimally invasive AVR through upper partial sternotomy was introduced by Svensson in 1997 [ 8 ]. Currently, upper partial sternotomy has been widely used in the context of aortic valve surgery, aortic root surgery, and even acute type A aortic dissection surgery [ 9 ]. AVR through partial upper sternotomy can yield excellent results in terms of postoperative pain and reduction of hospitalization, ventilation times, occurrence of renal failure, and need for blood transfusion [ 3 , 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Do obese patients benefit from isolated aortic valve replacement through a partial upper sternotomy?

Xie

Dai

Qiu

et al. 2022

J Cardiothorac Surg

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Objective Controversial opinions exist for aortic valve replacement (AVR) through partial upper sternotomy in obese patients. Moreover, this study sought to investigate the potential clinical advantage of partial upper sternotomy aortic valve replacement (mini-AVR) over conventional full sternotomy aortic valve replacement (con-AVR) in obese patients. Methods This was a retrospective and observational study. From January 2015 to December 2020, a total of 184 obese [body mass index (BMI) ≥ 30 kg m2] patients undergoing isolated primary AVR were included: 98 patients underwent conventional full sternotomy, and 86 patients underwent partial upper sternotomy. Propensity score (PS) matching was applied to eliminate the bassline imbalances in the mini-AVR and the con-AVR groups. Results After one-to-one propensity score matching, two groups of 60 patients were obtained. No in-hospital death occurred in the two groups. In addition, cardiopulmonary bypass time and total operative time were similar across the 2 groups, but the aortic cross-clamp time was significantly shorter in the con-AVR group (P = .0.022). The amount of mediastinal drainage at 48 h after surgery (P = 0.018) and postoperative blood transfusions (P = 0.014) were significantly lower in the mini-AVR group. There was no difference in ventilation time (P = .0.145), but a shorter intensive care unit stay time (P = 0.021) in the mini-AVR group. Conclusion This study demonstrates that aortic valve replacement through a mini-AVR in obese patients is a safe and effective procedure. It outperformed con-AVR in terms of blood loss, blood product transfusion, and ICU stay.

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“…In their article in this issue of the Journal, Xie and coworkers 1 report on a particularly rare and surprising experience of surgical repair of acute type A aortic dissection. Their report raises several important questions.…”

Section: Jean Bachet MD Febctsmentioning

confidence: 99%

Commentary: Is the type of chest opening the main problem in surgery for acute type A aortic dissection?

Bachet¹

2022

The Journal of Thoracic and Cardiovascular Surgery

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Extensive repair of acute type A aortic dissection through a partial upper sternotomy and using complete stent-graft replacement of the arch

Cited by 10 publications

References 18 publications

Surgical outcomes associated with partial upper sternotomy in obese aortic disease patients

Surgical outcomes associated with partial upper sternotomy in obese aortic disease patients

Do obese patients benefit from isolated aortic valve replacement through a partial upper sternotomy?

Commentary: Is the type of chest opening the main problem in surgery for acute type A aortic dissection?

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