Surgery of the ascending aorta, root remodelling and aortic arch surgery with circulatory arrest through partial upper sternotomy: results of 50 consecutive cases

Deschka, Heinz; Erler, Stefan; Machner, Matthias; El-Ayoubi, Lémir; Alken, Aiman; Wimmer‐Greinecker, Gerhard

doi:10.1093/ejcts/ezs341

Cited by 51 publications

(46 citation statements)

References 12 publications

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“…PUS is the most common access in minimally invasive procedures and even allows for management of aortic pathologies including the aortic root, ascending aorta and proximal aortic arch in experienced hands [22][23][24][25]. Compared with standard full sternotomy, PUS reduces postoperative ventilation time, ICU stay, bleeding complications, transfusion requirements, risk of mediastinitis, hospital length of stay, pain and costs.…”

Section: Commentmentioning

confidence: 99%

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Minimally invasive approach for aortic arch surgery employing the frozen elephant trunk technique

Ahmad

Risteski

Papadopoulos

et al. 2016

Eur J Cardiothorac Surg

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OBJECTIVES: Classically, repair of extensive thoracic aortic pathologies including the aortic arch and descending aorta required two separate major surgical procedures via full sternotomy and a subsequent left lateral thoracotomy. We describe herein our preliminary institutional experience with minimally invasive single-stage extended thoracic aortic replacement employing the frozen elephant trunk (FET) technique via partial upper sternotomy (PUS) in 14 patients. METHODS:Between December 2013 and January 2015, 14 consecutive patients with elective indications for FET underwent minimally invasive FET via PUS (PUS-FET) during moderate systemic hypothermia (28°C) and selective antegrade cerebral perfusion (ACP) using the E-vita Open® hybrid prosthesis ( Jotec GmbH, Hechingen, Germany). The patients' mean age was 66 ± 6 years, and 9 patients (64%) were male. The arch vessels were reimplanted en bloc in all patients. Clinical data were prospectively entered into our institutional database. RESULTS:The surgical procedure was successful in all patients with no need for conversion to full sternotomy. An additional David procedure was performed in 1 patient, whereas 2 patients received a concomitant Bentall procedure. There was no perioperative death or 30-day mortality. The mean cardiopulmonary bypass time was 214 ± 35 min, and the myocardial ischaemic time was 125 ± 14 min. The ACP time was 54 ± 9 min, whereas the ventilation time reached 11 ± 4 h. Intensive care unit stay was 2 ± 3 days. Chest tube drainage within the first 24 h was 460 ± 130 ml. None of the 14 patients required re-exploration for bleeding. Patients were discharged after a hospital length of stay of 9 ± 2 days. No postoperative permanent neurological complication occurred. Two patients (14%) experienced temporary delirium with complete resolution of symptoms prior to discharge from the hospital. CONCLUSIONS: Our preliminary experience suggests that minimally invasive single-stage extended thoracic aortic replacement can safely and reproducibly be performed by employing the concept of PUS-FET.

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Section: Commentmentioning

confidence: 99%

“…Compared with standard full sternotomy, PUS reduces postoperative ventilation time, ICU stay, bleeding complications, transfusion requirements, risk of mediastinitis, hospital length of stay, pain and costs. Furthermore, PUS offers a rapid postoperative recovery and cosmetic advantages [24,25].…”

Section: Commentmentioning

confidence: 99%

Minimally invasive approach for aortic arch surgery employing the frozen elephant trunk technique

Ahmad

Risteski

Papadopoulos

et al. 2016

Eur J Cardiothorac Surg

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“…Также несомненным преимуществом является сохранение одной из апертур грудной клетки и ее каркасной функции, что значительно снижает потребность пациентов в искусственной вентиляции легких в послеоперационном периоде и, согласно данным литературы [6][7][8], позволяет осуществить более раннюю экстубацию пациентов. По данным ряда авторов [6,[9][10][11], что подтверждается и опытом РНЦХ им. акад.…”

Section: Discussionunclassified

J-shaped mini-sternotomy for frozen elephant trunk procedure

Charchyan¹,

Скворцов²,

Golovina³

et al. 2018

Kardiol. serdechno-sosud. khir.

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“…3 Upper partial sternotomy has been used in ascending aortic and aortic arch operations, including hemiarch and total arch replacement. 4 A T-shaped partial lower sternotomy beginning at the 2nd intercostal space was used for aortic root and partial arch replacement in a patient with a prior tracheostomy. 5 Partial lower sternotomy has been reported in 28 patients 6 who underwent mitral valve replacement or repair, tricuspid valve repair, or AVR; 2 of the patients also underwent left internal mammary artery-to-left anterior descending coronary artery anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Aortic Hemiarch Replacement through a J-Shaped Lower Partial Sternotomy

Waterford¹,

Rastegar²,

Juan³

et al. 2015

Texas Heart Institute Journal

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Minimally invasive cardiac surgical techniques include the use of partial sternotomy for aortic valve and mitral valve replacement. Partial sternotomy is associated with less pain, better chest and upper-sternal stability, shorter hospital stays, and faster recoveries. However, aortic arch operations are still typically performed through median sternotomies. We describe the case of a 77-year-old woman who underwent elective hemiarch replacement because of an asymptomatic ascending aortic aneurysm. She requested a minimal incision. Our J-shaped partial lower sternotomy adequately exposed the proximal aorta and enabled all cannulations to be performed through the sternotomy. The patient had an uncomplicated postoperative course. We think that a partial sternotomy for ascending aortic and hemiarch replacement can be considered in selected patients for whom the procedure's benefits are important.

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Surgery of the ascending aorta, root remodelling and aortic arch surgery with circulatory arrest through partial upper sternotomy: results of 50 consecutive cases

Cited by 51 publications

References 12 publications

Minimally invasive approach for aortic arch surgery employing the frozen elephant trunk technique

Minimally invasive approach for aortic arch surgery employing the frozen elephant trunk technique

J-shaped mini-sternotomy for frozen elephant trunk procedure

Aortic Hemiarch Replacement through a J-Shaped Lower Partial Sternotomy

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