Ministernotomy in Aortic Root and Arch Surgery: Early Outcomes

ABSTRACT Introduction: Minimally invasive methods have become more preferred in cardiac surgery today. In this study, the comparative results of patients who underwent an aortic root, arch or hemiarch replacement by ministernotomy and full sternotomy in our clinic are presented. Methods: Between January 2017 and October 2019, a series of operations including aortic root, ascending aorta, and aortic arch replacements were performed on 278 patients. The ministernotomy technique was used in 25 of them. Twenty patients who underwent full sternotomy were selected and matched to this group for comparison. Results: The ministernotomy group had a longer cross-clamping time (128.3±30.8 vs. 104.7±23.4 min, P=0.007) but the total operating time was similar in the two groups (249.76±28.56 vs. 248.25±37.53 min, P=0.879). The number of red blood cell (RBC) transfusions per patient was higher in the full sternotomy group (4.65±3.74 vs. 2.44±1.85 unit, P=0.020). The ministernotomy group had shorter ventilation times (7.60±4.88 vs. 32.30±32.25 h, P<0.001) and shorter ICU stay (1.56±0.58 vs. 3.35±1.46 d, P<0.001). The 30-day mortality was 0% in the ministernotomy group. Conclusion: Early results of our study show that, in combined or isolated aortic root, ascending aorta, and aortic arch surgeries, ministernotomy can be applied with relatively safety and low mortality and morbidity rates.

摘要
引言：微创术式目前在心脏外科领域愈发受到青睐。本研究汇报了本中心采用微创胸骨切开术与完全胸骨切开术行主动脉根部、弓部或半弓置换术患者的对比研究结果。
方法：2017年1月至2019年10月期间，本中心共完成278例含主动脉根部、升主动脉及主动脉弓置换术在内的手术。其中25例采用微创胸骨切开术方案，另选取20例行完全胸骨切开术的患者作为匹配对照组进行对照分析。
结果：微创胸骨切开术组的主动脉阻断时间更长（128.3±30.8 vs. 104.7±23.4 min，P=0.007），但两组总手术时间无统计学差异（249.76±28.56 vs. 248.25±37.53 min，P=0.879）。完全胸骨切开术组患者的人均红细胞（RBC）输注量更高（4.65±3.74 vs. 2.44±1.85 单位，P=0.020）。微创胸骨切开术组的呼吸机辅助通气时间更短（7.60±4.88 vs. 32.30±32.25 h，P<0.001），ICU停留时间也更短（1.56±0.58 vs. 3.35±1.46 d，P<0.001）。微创胸骨切开术组的30天死亡率为0%。
结论：本研究早期结果显示，在联合或单纯主动脉根部、升主动脉及主动脉弓手术中，微创胸骨切开术应用安全性良好，且死亡率与并发症发生率均较低。