Comparison of Totally Endoscopic Replacement of the Ascending Aorta and the Aortic Root via Right Anterior Mini-Thoracotomy Versus Complete Sternotomy

Background: Minimally invasive surgery via right anterolateral mini-thoracotomy (RAMT) access has been gaining popularity in cardiac surgery to optimize surgical results, reduce surgical trauma, and sternotomy-associated complications. Standard surgical approach for the treatment of pathologies of the ascending aorta (AA) and the aortic root is the complete sternotomy (CS). Aim of the actual study is to compare postoperative outcomes between RAMT and CS in patients undergoing replacement of the AA (AAR) and the aortic root.

Methods: We retrospectively analyzed the clinical data of 186 patients who underwent AAR with or without the need of aortic valve replacement (AVR) via RAMT (n = 57) or CS (n = 129) between August 2018 and July 2024. All patients with acute or chronic aortic dissection as well as patients who received complete arch replacement, redo surgery, multiple valve surgery, or additional CABG were excluded from the study. Early postoperative outcome as well as ventilation time, length of intensive care unit (ICU), and 30-day mortality were analyzed.

Results: Mean age was 61.0 ± 12.3 years, with 25.8% of female gender. Baseline characteristics did not differ between the groups. EuroScore II was higher in CS patients (3.3% versus 2.3%; p = 0.018). Aortic x-clamp time was shorter in RAMT (64.9 versus 84.7 minutes, p = 0.003). Conversion to sternotomy was zero in RAMT group. 30-day mortality was 1.1%. A trend to more wound infection was seen in CS patients (5.4% versus 0.0%; p = 0.073). CS was associated with higher postoperative delirium (20.2% versus 7.0%; p = 0.025), re-intubation rate (7.0% versus 0.0%; p = 0.041), longer ventilation time (37.0 versus 6.8 hours; p < 0.001), and prolonged ICU (81.1 vs. 36.1 hours; p = 0.003) and in-hospital stay (11.5 versus 8.1 days; p = 0.020).

Conclusion: To avoid sternotomy-associated complications, the full endoscopic RAMT approach with 3D visualization should be adopted in the field of aortic surgery as safe, feasible, and promising technique without compromising surgical quality, postoperative outcomes, or patient safety when performed by an experienced team in a high-volume center.

Publikationsverlauf

Artikel online veröffentlicht:
11. Februar 2025