Long-term outcomes of mini-sternotomy versus full sternotomy valve-sparing aortic root replacement.

P0198 

Abstract Submission 

Jakub Staromlynski (1), Adam Kowalowka (2), Radoslaw Gocol (2), Damian Hudziak (2), Damian Chudzik (2), Małgorzata Żurawska (1), Wojciech Nowak (1), Michal Pasierski (1), Wojciech Sarnowski (1), Radosław Smoczyński (1), Maciej Bartczak (1), Jakub Brączkowski (1), Sabina Sadecka (1), Dominik Drobiński (1), Marek Deja (2), Mariusz Kowalewski (3), Piotr Suwalski (1)

(1) National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland, (2) Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland, (3) IRCCS-ISMETT, Palermo, Italy

Jakub Staromlynski    -  Contact Me
National Medical Institute of the Ministry of Interior and Administration

Adam Kowalowka    -  Contact Me
Medical University of Silesia, School of Medicine in Katowice

Radoslaw Gocol    -  Contact Me
Medical University of Silesia, School of Medicine in Katowice

Damian Hudziak    -  Contact Me
Medical University of Silesia, School of Medicine in Katowice

Damian Chudzik    -  Contact Me
Medical University of Silesia, School of Medicine in Katowice

Małgorzata Żurawska    -  Contact Me
National Medical Institute of the Ministry of Interior and Administration

Wojciech Nowak    -  Contact Me
National Medical Institute of the Ministry of Interior and Administration

Michal Pasierski    -  Contact Me
National Medical Institute of the Ministry of Interior and Administration

Wojciech Sarnowski    -  Contact Me
National Medical Institute of the Ministry of Interior and Administration

Radosław Smoczyński    -  Contact Me
National Medical Institute of the Ministry of Interior and Administration

Maciej Bartczak    -  Contact Me
National Medical Institute of the Ministry of Interior and Administration

Jakub Brączkowski    -  Contact Me
National Medical Institute of the Ministry of Interior and Administration

Sabina Sadecka    -  Contact Me
National Medical Institute of the Ministry of Interior and Administration

Dominik Drobiński    -  Contact Me
National Medical Institute of the Ministry of Interior and Administration

*Marek Deja    -  Contact Me
Medical University of Silesia, School of Medicine in Katowice

Mariusz Kowalewski    -  Contact Me
IRCCS-ISMETT

Piotr Suwalski    -  Contact Me
National Medical Institute of the Ministry of Interior and Administration

Jakub Staromlynski    -  Contact Me
N/A

Objective: Valve-sparing aortic root replacement (VSARR) is a favored method for repairing aortic root aneurysms in patients with suitable anatomy and a reasonable life expectancy, as numerous studies have demonstrated excellent long-term outcomes. Despite the increasing use of minimally invasive techniques in cardiac surgery, there is limited data on minimally invasive VSARR. This study aimed to compare the long-term survival and durability of repairs between VSARR performed via full sternotomy (FS) or ministernotomy (MS).

Methods: We gathered data prospectively of all VSARR procedures at two high-volume tertiary centers. Starting in 2014, one center adopted a MS approach for aortic root aneurysms below 65 mm. The primary endpoint was long-term mortality, while the secondary endpoint involved repair durability, measured by the degree of aortic insufficiency at the longest follow-up, perioperative complications, and the need for further intervention.

Results: Ninety-four patients were included in the study (21 in the MS group and 73 in the FS group). The median age [interquartile range, IQR] of patients was 46 [32-62], and the median EuroSCORE II was 2.48 [1.29-3,36]. The aortic cross clamp duration was 35 minutes longer in the MS group [median 160 (143-184) vs. 195 (171-212), p=0.011]. There were no differences in perioperative complications, including kidney failure requiring dialysis (p=0.399), re-exploration for bleeding (p=0.705), neurological complications (p>0.999), or ICU stay (p=0.700). The 30-day mortality was 4.1% (3 out of 73) in FS group and 0% in MS group (p>0.999). In a median clinical follow-up of 5.1 years, there were no differences in survival between the groups (logrank test, p=0.260). Four patients (5.4%) in the FS group and no patients in MS required re-intervention during follow-up (p=0.572). Similarly, in a median echocardiographic follow-up of 2.0 years, there were no differences in the progression to ≥moderate aortic regurgitation between the groups (p>0.999).

Conclusions: Minimally invasive VSARR appears to be safe and shows comparable survival and durability to the FS approach among patients with aortic root aneurysms below 65 mm.

Aortic Root