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Ann Thorac Surg 2002;74:S1786-S1788
© 2002 The Society of Thoracic Surgeons

Session 1: Ascending Aorta

Progress in ascending and aortic arch surgery: minimally invasive surgery, blood conservation, and neurological deficit prevention

Lars G. Svensson, MD, PhDa*

a Center for Aortic Surgery and Marfan Syndrome and Connective Tissue Disorder Clinic, Department of Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

* Address reprint requests to Dr Svensson, Center For Aortic Surgery, Marfan and Connective Tissue Disorder Clinic, The Cleveland Clinic Foundation, 9500 Euclid Ave, F25, Cleveland, OH, 44195, USA
e-mail: svenssl{at}ccf.org

Presented at the Aortic Surgery Symposium VIII, May 2–3, 2002, New York, NY.

Abstract

BACKGROUND: Herein are described recent developments in aortic surgery techniques and the improved results.

METHODS: Of 403 ascending and aortic arch operations, 68 patients underwent minimally invasive aortic surgery including 23 for aortic dissection, 5 for Marfan syndrome, 29 reoperations, and 39 with hypothermic arrest. Blood conservation methods were used in 187 of the 403 patients (46.5%). Aortic valve procedures were used in 267 (66.2%), including 51 (12.7%) valve-preserving operations. A protocol for stroke and neurocognitive deficit prevention was used in an attempt to prevent neurologic deficits. Data were prospectively collected and included new neurocognitive events either by formal testing (n = 35) or by informal questioning.

RESULTS: Stroke occurred in 2.0% (8 of 403); clinical gross neurocognitive deficits in 2.5% (10 of 403) with a 98% 30-day survival. For those patients undergoing the minimally invasive operation 1 hospital death occurred (98.5% survival). Homologous operative transfusions were required in only 12% of blood conservation patients (23 of 187) and their postoperative intubation time, intensive care unit (ICU) stay, and hospital stay were significantly shorter (p < 0.04).

CONCLUSIONS: Minimally invasive surgery is particularly useful for reoperations. The blood conservation methods appear to be beneficial and the number of neurologic deficits is low with the current protocol.




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