Successful Use of Sternal-Sparing Minimally Invasive Surgery for Proximal Ascending Aortic Pathology

Lamelas, Joseph; Chen, Peter C.; Loor, Gabriel; LaPietra, Angelo

doi:10.1016/j.athoracsur.2018.03.081

Cited by 25 publications

(48 citation statements)

References 21 publications

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“…This approach is associated with shorter recovery time and reduced blood loss. 19 The major disadvantage of this procedure is the longer circulatory arrest time required compared with traditional approaches. Meticulous attention to maintaining hemostasis is critical in this approach, because bleeding will be more difficult to control, particularly at the left main coronary artery anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Right Mini-thoracotomy Bentall Procedure

Johnson

Siordia²,

Wood

et al. 2018

Innovations�(Phila)

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Objective Bentall procedures are traditionally performed through a median sternotomy. The right mini-thoracotomy approach is increasingly used in aortic valve replacement. This approach has been shown to have decreased blood loss and hospital length of stay compared with sternotomy. A right mini-thoracotomy approach may also be beneficial in selected patients requiring aortic root surgery. We present our initial clinical experience of patients who have undergone a right mini-thoracotomy Bentall. Methods This is a single-center retrospective review of seven patients who underwent a primary elective right anterior mini-thoracotomy Bentall. A thoracoscope was used in each case. Automated suturing technology was used for annular suturing in three of the seven patients. Clinical outcomes evaluated include 30-day mortality, intensive care and hospital length of stay, time to extubation, operative times, as well as postoperative sequelae including stroke, infection, and bleeding. Results Median cardiopulmonary bypass, cross-clamp, and circulatory arrest time were 217, 153, and 28 minutes, respectively. Median time to extubation was 10 hours and median intensive care unit and hospital stay was 1 and 4 days, respectively. One patient had a wound infection and one returned to the operating room for bleeding. There were no in-hospital or 30-day mortalities. Conclusions The Bentall procedure can be performed through a right anterior mini-thoracotomy in selected patients with excellent clinical results.

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Section: Discussionmentioning

confidence: 99%

Right Mini-thoracotomy Bentall Procedure

Johnson

Siordia²,

Wood

et al. 2018

Innovations�(Phila)

View full text Add to dashboard Cite

show abstract

“…Despite a longer circulatory arrest times in the minimally invasive group, stroke rate, as well as the transfusion requirements, ventilation times, as well as the ICU and hospital stays were less than the sternotomy group. 35…”

Section: Discussionmentioning

confidence: 99%

Antegrade Versus Retrograde Cerebral Perfusion for Ascending Aorta and Aortic Arch Replacement: Literature Review

Alnajar

Aleong

Azhar

et al. 2020

Preprint

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Aortic arch and hemiarch surgery necessitate the temporary interruption of blood perfusion to the brain. Despite its complexity, hemiarch and ascending aortic surgery can be performed via a minimally invasive approach. Due to the higher risk of neurological injury during circulatory arrest, several techniques were developed to further protect the brain during this surgery. We searched the Embase, Medline, and Cochrane databases and identified articles reporting outcomes of antegrade and retrograde cerebral perfusion strategies. Herein, we outline surgical approaches, intra-operative technical considerations, and clinical outcomes of hemiarch and ascending aortic surgery.

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“…45 The initial outcomes of the first reported minimally invasive, right minithoracotomy replacement of the ascending aorta and aortic valve in 20 patients was excellent; with no strokes, reoperations for bleeding, conversions to sternotomy, or 30-day mortality. 46 In 2018, Lamelas et al 47 further described their experience with sternalsparing replacement of the ascending aorta, with or without a concomitant aortic valve replacement, via a right mini-thoracotomy in 74 patients. This study was followed by a propensity score-matched analysis performed between 63 patients undergoing a sternotomy and an equivalent number of patients undergoing a minimally invasive nonsternotomy approach.…”

Section: Clinical Outcomes From Studies Utilizing Both Strategiesmentioning

confidence: 99%

“…Despite longer circulatory arrest times in the minimally invasive group, stroke rate, ventilation times, transfusion requirements, and length of ICU and hospital stays were less than in the sternotomy group. 47…”

Section: Clinical Outcomes From Studies Utilizing Both Strategiesmentioning

confidence: 99%

Review of cerebral perfusion strategies for aortic surgery with application for minimally invasive approaches

et al. 2020

Self Cite

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Aortic arch and hemiarch surgery necessitate the temporary interruption of blood perfusion to the brain. Despite its complexity, hemiarch and ascending aortic surgery can be performed via a minimally invasive approach. Due to the higher risk of neurological injury during a circulatory arrest, several techniques were developed to further protect the brain during this surgery. We searched the Embase, Medline, and Cochrane databases and identified articles reporting outcomes of antegrade and retrograde cerebral perfusion strategies. Herein, we outline surgical approaches, intra-operative technical considerations, and clinical outcomes of hemiarch and ascending aortic surgery. Hemiarch and ascending aortic surgery is associated with a higher risk of mortality and morbidity. Attention to the optimal approach and cerebral protection strategy has been shown to significantly affect outcomes and mitigate risk.

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Successful Use of Sternal-Sparing Minimally Invasive Surgery for Proximal Ascending Aortic Pathology

Abstract: A sternal-sparing approach to surgery of the proximal aorta is safe when performed by an experienced surgeon and conserves hospital resources.

Cited by 25 publications

References 21 publications

Right Mini-thoracotomy Bentall Procedure

Right Mini-thoracotomy Bentall Procedure

Antegrade Versus Retrograde Cerebral Perfusion for Ascending Aorta and Aortic Arch Replacement: Literature Review

Review of cerebral perfusion strategies for aortic surgery with application for minimally invasive approaches

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