Expanding the Minimally Invasive Approach for Replacement of the Ascending Aorta towards the Proximal Aortic Arch

P0131 

Abstract Submission 

Florian Helms (1), Heike Krueger (1), Ruslan Natanov (1), Andreas Martens (1), Alina Zubarevich (1), Bastian Schmack (1), Alexander Weymann (1), Arjang Ruhparwar (1), Aron Popov (1)

(1) Hannover Medical School, Hannover, Lower Saxony, Germany

Florian Helms    -  Contact Me
Hannover Medical School

Heike Krueger    -  Contact Me
Hannover Medical School

Ruslan Natanov    -  Contact Me
Hannover Medical School

Andreas Martens    -  Contact Me
Hannover Medical School

Alina Zubarevich    -  Contact Me
Hannover Medical School

Bastian Schmack    -  Contact Me
Hannover Medical School

Alexander Weymann    -  Contact Me
Hannover Medical School

Arjang Ruhparwar    -  Contact Me
Hannover Medical School

Aron Popov    -  Contact Me
Hannover Medical School

Florian Helms    -  Contact Me
N/A

Objective
Over the last decade, the minimally invasive access has become more and more the standard approach for aortic valve and aortic root replacement. As the next logical step, minimally invasive approaches for more complex operations of the supracommissural ascending aorta and proximal aortic arch have currently moved into the center of attention. While there is a broad evidence basis for minimally invasive aortic root and aortic valve replacements, currently available evidence focusing on the supracommissural aorta and the proximal aortic arch is still scarce to date.

Methods
We present our single center experience of 86 consecutive patients who underwent supracommissural ascending aorta replacement with or without proximal aortic arch replacement via an upper J-shaped hemisternotomy between June 2009 and April 2023. Data regarding patient characteristics, surgical procedures, postoperative outcome, and overall survival was collected prospectively in our institutional database and analyzed retrospectively.

Results
Mean patient age was 65.4 ± 13.6 years, 42% (n=36) were male. In 40 cases (45.5%), proximal aortic arch replacement was performed while in the remaining cases, patients received isolated replacement of the supracommissural aorta. Mean operation time was 202.9 ± 50 minutes and cross-clamp time was 52.2 ± 18.9 minutes. Conversion to full sternotomy was necessary in one case (1.2%). One patient required re-thoracotomy due to bleeding after proximal aortic arch repair. Re-operation rate was 0%. In-hospital mortality was 1.2% (n=1) and 30-day mortality was 2.3% due to two early deaths (one after isolated ascending aortic repair and one after proximal arch replacement). With a mean follow-up time of 5.7 years, Kaplan-Meier analysis revealed an overall survival of 90.5% with no statistically significant differences between patients undergoing isolated supracommissural ascending aorta replacement and cases with additional proximal arch replacement (93.2% vs. 87.5%, p = 0.45).

Conclusions
Supracommissural ascending aortic replacement as well as proximal aortic arch repair can be safely performed via a minimally invasive approach with a low conversion rate. Short- and long-term survival are comparable to results previously reported for complete sternotomy. Expanding the indication for the minimally invasive access towards the proximal aortic arch did not impair short- and long-term survival.

Ascending Aorta