Minimal access surgery of ascending and proximal arch of the aorta: a 9-year experience

Background Minimal access approaches are becoming readily accepted techniques for cardiac valve surgery. However, the safety or benefit of this approach for aortic surgery has not been well investigated. Methods We retrospectively analyzed 128 consecutive patients who underwent ascending aortic replacement (n = 53), proximal aortic arch replacement (n = 7), aortic root replacement (n = 67), or sinus of Valsalva aneurysm repair (n = 1) through an upper hemisternotomy between August 1996 and May 2005. Using matched variables (age, type of procedure, redo operation, and use of circulatory arrest), we constructed two matched cohorts of 79 patients each: a minimally invasive (group A) and full sternotomy (group B) and compared outcomes. Results The mean age for the minimally invasive group (n = 128) was 54 years (range, 25 to 83 years). There were six reoperations (4.7%), five (3.9%) urgent operations, and 16 (12.5%) deep hypothermic circulatory arrests. Operative mortality was zero, the median length of hospital stay was 5 days (range, 3 to 21 days), and 112 patients (82.4%) were discharged home. Actuarial survival at 5 years was 97.2%. On comparison between group A and B, there was no significant difference in operative times, mortality, and morbidity. However, group A had shorter median length of stay (5 versus 6 days, p = 0.020) and fewer median units of red blood cell transfusion than group B (2 versus 2.5, p = 0.020). Conclusions An upper hemisternotomy approach is safe and feasible for ascending aortic and proximal arch surgical procedures, with excellent early and late outcomes. This approach is associated with shorter hospital stay and less blood transfusion.