Isolated or Combined Ascending Aortic Replacement through a Partial Sternotomy: Early and Midterm Outcomes

Abstract

Background We aimed to investigate the in-hospital and midterm outcomes of patients undergoing ascending aortic replacement (AAR) through a partial or a full sternotomy approach through a propensity matching analysis.

Methods We retrospectively included all patients (n = 167) who underwent elective AAR in our institution between 2013 and 2020. The study population was divided into two groups according to the surgical access (40 patient in the partial sternotomy or “PS” group and 127 in the full sternotomy or “FS” group). Due to the significant differences between the groups, a propensity matching of 1:3 was applied. In-hospital complications, survival, and reoperation at follow-up were investigated.

Results The PS group showed higher cross-clamp and cardiopulmonary bypass times than the FS group (94.2 vs. 83 minutes and 164.2 vs. 126.8 minutes, respectively). Moreover, the postoperative ventilation time was significantly higher in the PS group, but it did not affect the length of stay in the intensive care unit (ICU). The incidences of bleeding, stroke, and mortality were comparable between the two groups (11 vs. 3%, 3 vs. 6%, and 5 vs. 3%, respectively). After a median follow-up of 2 ± 1.98 years, the Kaplan–Meier analysis showed no significant differences between the two groups (log-rank, p = 0.17) in terms of survival.

Conclusion The surgical ascending aorta replacement through a partial sternotomy is associated with longer operative times, but this does not affect the early as well as the long-term follow-up.

Keywords

minimally invasive surgery - aorta/aortic - aneurysm

Note

A part of the present study was performed in fulfilment of the requirements for obtaining the doctoral degree of M. Angerer.

Ethical Approval Statement

This study was approved by the hospital study center (SZ_D_159.21-I-6) and institutional review board of the Paracelsus Medical University–Campus Nuremberg (IRB-2022–015) and was conducted in accordance with the principles of the Declaration of Helsinki. A written consent was obtained from all patients for the anonymous use of in-hospital data, while a verbal consent was obtained for the telephonic follow-up.

Authors' Contribution

M.A. contributed to data collection and validation, interpretation of data, drafting of the manuscript. F.P. contributed to conception and design, data collection and validation, interpretation of data, drafting of the manuscript. W.H. contributed to statistical analysis and interpretation of data. L.W. contributed to data collection and revising of the manuscript. J.S. contributed to data collection and revising of the manuscript. T.F. contributed to critical revision of the manuscript.

^* These authors contributed equally and are joint first author.

Publikationsverlauf

Eingereicht: 05. September 2023

Angenommen: 02. Februar 2024

Artikel online veröffentlicht:
16. April 2024

• References

• 1 Isselbacher EM, Preventza O, Hamilton Black Iii J. et al; Writing Committee Members. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 80 (24) e223-e393
• 2 Mori M, Shioda K, Wang X. et al. Perioperative risk profiles and volume-outcome relationships in proximal thoracic aortic surgery. Ann Thorac Surg 2018; 106 (04) 1095-1104
• 3 Skoglund Larsson L, Ljungberg J, Johansson L, Carlberg B, Söderberg S, Brunström M. Survival after surgery of the ascending aorta: a matched cohort study. Eur J Cardiothorac Surg 2022; 62 (03) ezac161
• 4 Paparella D, Malvindi PG, Santarpino G. et al. Full sternotomy and minimal access approaches for surgical aortic valve replacement: a multicentre propensity-matched study. Eur J Cardiothorac Surg 2020; 57 (04) 709-716
• 5 Russo MJ, Thourani VH, Cohen DJ. et al. Minimally invasive versus full sternotomy for isolated aortic valve replacement in low-risk patients. Ann Thorac Surg 2022; 114 (06) 2124-2130
• 6 Lentini S, Specchia L, Nicolardi S. et al. Surgery of the ascending aorta with or without combined procedures through an upper ministernotomy: outcomes of a series of more than 100 patients. Ann Thorac Cardiovasc Surg 2016; 22 (01) 44-48
• 7 Staromłyński J, Kowalewski M, Sarnowski W. et al. Midterm results of less invasive approach to ascending aorta and aortic root surgery. J Thorac Dis 2020; 12 (11) 6446-6457
• 8 Haunschild J, van Kampen A, von Aspern K. et al. Supracommissural replacement of the ascending aorta and the aortic valve via partial versus full sternotomy-a propensity-matched comparison in a high-volume centre. Eur J Cardiothorac Surg 2022; 61 (02) 479-487
• 9 Pfeiffer S, Fischlein T, Vogt F, Santarpino G. Superior vena cava cannulation in aortic valve surgery: an alternative strategy for a hemisternotomy approach. Interact Cardiovasc Thorac Surg 2015; 20 (06) 863-865
• 10 Akins CW, Miller DC, Turina MI. et al; STS, AATS, EACTS. Guidelines for reporting mortality and morbidity after cardiac valve interventions. Ann Thorac Surg 2008; 85 (04) 1490-1495
• 11 Deschka H, Erler S, Machner M, El-Ayoubi L, Alken A, Wimmer-Greinecker G. Surgery of the ascending aorta, root remodelling and aortic arch surgery with circulatory arrest through partial upper sternotomy: results of 50 consecutive cases. Eur J Cardiothorac Surg 2013; 43 (03) 580-584
• 12 Young CP, Sinha S, Vohra HA. Outcomes of minimally invasive aortic valve replacement surgery. Eur J Cardiothorac Surg 2018; 53 (Suppl. 02) ii19-ii23