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Minoru Tabata
Zain Khalpey
Sary F. Aranki
Gregory S. Couper
Lawrence H. Cohn
Prem S. Shekar
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Ann Thorac Surg 2007;84:67-72
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Minimal Access Surgery of Ascending and Proximal Arch of the Aorta: A 9-Year Experience

Minoru Tabata, MD, Zain Khalpey, MD, PhD, Sary F. Aranki, MD, Gregory S. Couper, MD, Lawrence H. Cohn, MD, Prem S. Shekar, MD*

Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Massachusetts

Accepted for publication March 12, 2007.

* Address correspondence to Dr Shekar, Division of Cardiac Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02446 (Email: pshekar{at}partners.org).

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.


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Invited commentary
Friedrich S. Eckstein
Ann. Thorac. Surg. 2007 84: 72. [Extract] [Full Text] [PDF]



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F. S. Eckstein
Invited commentary
Ann. Thorac. Surg., July 1, 2007; 84(1): 72 - 72.
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