The Arrowhead Ministernotomy with Rigid Sternal Plate Fixation: A Minimally Invasive Approach for Surgery of the Ascending Aorta and Aortic Root

Russo, Mark J.; Gnezda, John; Merlo, Álvaro Roberto Crespo; Johnson, Elizabeth; Hashmi, Mohammad; Raman, Jaishankar

doi:10.1155/2014/681371

Cited by 9 publications

(6 citation statements)

References 10 publications

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“…The preserved thoracic stability allows for faster mobilization and recuperation resulting in shorter hospital stay in addition to better cosmetic results. [1][2][3] The aim of this study was to demonstrate the feasibility and safety of a minimally invasive approach to aortic arch surgery.…”

mentioning

confidence: 99%

Minimally Invasive Access Aortic Arch Surgery

Goebel

Bonte

Salehi-Gilani

et al. 2017

Innovations�(Phila)

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Objective Median sternotomy is still the standard approach for aortic arch surgery. Minimally invasive techniques promise faster recovery with shorter hospital stay due to thoracic stability, reduced pain, and superior cosmetic results. However, safety is a concern in complex aortic surgery. The aim of our study was to demonstrate that aortic arch surgery via partial upper sternotomy is viable, safe, and equivalent to standard procedure both in terms of its safety and the risk of major adverse cardiac and cerebrovascular events. Methods We interrogated our prospectively collected database and identified a total of 21 nonemergent patients operated on at our center between October 2008 and February 2015. Indication for operation was aneurysmatic disease in 18 and aortic dissection in 3 patients. Data were analyzed for in-hospital mortality, stroke, bleeding complications, and acute kidney injury. Results Mean ± standard deviation age of patients was 69.3 ± 14.4 years, 57.1% were female, and mean ± standard deviation logistic EuroSCORE was 17.0 ± 7.2%. Surgery on the aortic arch comprised proximal arch in 9, hemiarch in 9, and total arch replacement plus frozen elephant trunk in 3 patients. Concomitant procedures included aortic root repair in 10, aortic root replacement in 2, and aortic valve replacement in 3 patients. We lost one patient because of septic shock, no stroke occurred, but a transient neurologic deficit in three and a postoperative delirium in four patients. Re-exploration for bleeding was necessary in two patients, and one patient had acute kidney injury. Conclusions Minimally invasive aortic arch surgery via partial upper sternotomy does not increase the risk of morbidity or mortality. Thus, in experienced hands, it is viable, safe, and therefore favorable and as a result should be offered to more patients.

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mentioning

confidence: 99%

Minimally Invasive Access Aortic Arch Surgery

Goebel

Bonte

Salehi-Gilani

et al. 2017

Innovations�(Phila)

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“…On the other hand, doing an L-shaped MS increases the exposure of the proximal and distal aortic arch as well as the aortic root. A V or inverted T-shaped upper MS has been also reported by some groups [2,3]. While this access certainly improves visualization, it may reduce postoperative sternal stability and be associated with an increased risk of both left and right mammary arteries injury.…”

Section: Upper Msmentioning

confidence: 70%

Minimally invasive approach: is this the future of aortic surgery?

Berretta

Galeazzi

Cefarelli

et al. 2021

Indian J Thorac Cardiovasc Surg

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Median sternotomy incision has shown to be a safe and efficacious approach in patients who require thoracic aortic interventions and still represents the gold-standard access. Nevertheless, over the last decade, less invasive techniques have gained wider clinical application in cardiac surgery becoming the first-choice approach to treat heart valve diseases, in experienced centers. The popularization of less invasive techniques coupled with an increased patient demand for less invasive therapies has motivated aortic surgeons to apply minimally invasive approaches to more challenging procedures, such as aortic root replacement and arch repair. However, technical demands and the paucity of available clinical data have still limited the widespread adoption of minimally invasive thoracic aortic interventions. This review aimed to assess and comment on the surgical techniques and the current evidence on mini thoracic aortic surgery.

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“…The full median sternotomy can be restricted only to perform aortic root surgery in the presence of other concomitant cardiac pathologies, otherwise limited median sternotomy techniques are the best approach for isolated aortic root surgery due to shorter hospitalization periods, improved lung functions, reduced trauma effects, and early mobilization. There are two most preferred minimal invasive incision techniques for access into the mediastinum: J sternotomy is the most preferred ministernotomy incision in isolated AVR operations [29,30], but only upper reverse-T ministernotomy is an appropriate approach to reach the aortic root and to perform all varieties of aortic root surgeries [31,32]. After the usual preparations, standard central arterial cannulation is established through the distal ascending aorta or the lateral wall of the mid aortic arch.…”

Section: The Modified Bentall Technique Eliminates Wrapping Of the Namentioning

confidence: 99%

Isolated Aortic Root Aneurysms

Kırali¹,

Günay²

2017

Aortic Aneurysm

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The aortic root has a complex anatomy due to a combination of several anatomical structures based on simple and consistent work in it. It is a hollow cylinder with three bulges, which have the main functional effect on the aortic valve opening-closing cycle and coronary circulation. Aneurysm is defined as a dilation of a blood vessel segment having ≥50% increase in diameter, whereas annuloaortic ectasia represents a diffuse dilation <50% of the normal diameter of the related vessel segment. Aortic root aneurysms mostly occur by degenerative processes as compared with primarily atherosclerotic changes in the descending and abdominal aortas: medial fragmentation, smooth muscle cells necrosis, and elastic fiber fragmentations with cystic spaces in the media filled with mucoid material. Because of the elevated mortality risk associated with complications, an effective aortic root aneurysm management depends on reduction the risk of death, rupture, and dissection. Conventional open heart surgery is the essential procedure for isolated aortic root replacement and a type of procedure (valve replacement or sparing) could be selected due to the pathology. An extensive aortic root replacement technique is the only option to rebuild the left ventricular outflow tract due to the reconstruction of the neo aortoventricular continuity in the aortic root abscess.

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The Arrowhead Ministernotomy with Rigid Sternal Plate Fixation: A Minimally Invasive Approach for Surgery of the Ascending Aorta and Aortic Root

Cited by 9 publications

References 10 publications

Minimally Invasive Access Aortic Arch Surgery

Minimally Invasive Access Aortic Arch Surgery

Minimally invasive approach: is this the future of aortic surgery?

Isolated Aortic Root Aneurysms

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