Mini Sternotomy versus Conventional Sternotomy for Complex Aortic Surgery

P0217 

Abstract Submission 

Omar Jarral (1), Stevan Pupovac (2), Kenenna Onyebeke (3), Adam Kiridly (2), Chad Kliger (1), Kush Dholakia (1), Nirav Patel (1), S.Jacob Scheinerman (1), Alan Hartman (2), Derek Brinster (4)

(1) Lenox Hill Hospital, Northwell Cardiovascular Institute, New York, NY, (2) Northshore University Hospital, Northwell Cardiovascular Institute, New York, NY, (3) Zucker School of Medicine at Hofstra/Northwell, New York, NY, (4) Northwell Health, Lenox Hill Hospital, New York, NY

Omar Jarral    -  Contact Me
Lenox Hill Hospital, Northwell Cardiovascular Institute

Stevan Pupovac    -  Contact Me
Northshore University Hospital, Northwell Cardiovascular Institute

Kenenna Onyebeke    -  Contact Me
Zucker School of Medicine at Hofstra/Northwell

Adam Kiridly    -  Contact Me
Northshore University Hospital, Northwell Cardiovascular Institute

Chad Kliger    -  Contact Me
Lenox Hill Hospital, Northwell Cardiovascular Institute

Kush Dholakia    -  Contact Me
Lenox Hill Hospital, Northwell Cardiovascular Institute

Nirav Patel    -  Contact Me
Lenox Hill Hospital, Northwell Cardiovascular Institute

S.Jacob Scheinerman    -  Contact Me
Lenox Hill Hospital, Northwell Cardiovascular Institute

Alan Hartman    -  Contact Me
Northshore University Hospital, Northwell Cardiovascular Institute

Derek Brinster    -  Contact Me
Northwell Health, Lenox Hill Hospital

Omar Jarral    -  Contact Me
Lenox Hill Hospital

Objective
There has been growing interest in performing aortic surgery through a mini-sternotomy approach. There is limited evidence base, and studies are needed to establish its safety. The objective of this study was to assess our institutional outcomes for aortic surgery through a mini approach.

Methods
Institutional Database was used to retrospectively obtain characteristics for patients undergoing elective proximal aortic surgery (excluding redo's/chronic dissections) between 2015-2021. Multivariable logistic regression and propensity score adjustment was used to explore the influence of relevant variables on outcome.

Results
547 patients were included, of which 74 (13.5%) had a mini sternotomy. The mean age of the cohort was 61.6 (±14.5) years, and 121 (22.1%) were female. The mini group had significantly more females (32.4%, n=24 vs. 20.5%, n=97), BAV's (45.9%, n=34 vs. 30.6%, n=145), and a lower proportion with PVD (25.7%, n=19 vs 46.3%, n=219).

In terms of operative characteristics (mini vs. conventional), a total of 73 (13.3%, n=29 vs. 44) underwent ascending aorta (AA) replacement, 17 (3.1%, n=4 vs 13) underwent AV repair and AA, 198 (36.2%, n=35 vs. 163) underwent AV and AA replacement, 175 (32%, n=1 vs. 174) underwent root replacement, and 84 (15.4%, n=5 vs. 79) underwent VSRR. 307 patients (56.1%, n=70 vs. 237) required a arch procedure. The sternotomy group underwent significantly more root and VSRR (53.4% vs. 8.1%), and the mini group underwent significantly more arch procedures (94.6% vs. 50.1%).

Unadjusted outcomes were comparable between the mini and conventional group: 30-day mortality (2.8% vs. 1.3%), DSWI (2.8% vs. 1.1%), sepsis (4.1% vs. 2.1%), CVA (2.8% vs. 2.1%), ARF (2.8% vs. 1.7%), post-op length of stay (8.8 ± 5.9 vs. 7.9 ± 5.1 days), and ventilation time (40.3 ± 103.7 vs 27.2 ± 85.0 hours). However, re-op for bleeding (6.8% vs. 0.8%, p<0.001) and products transfused (9.6 ± 7.1 vs. 6.4 ± 7.4 units, p<0.001) were significantly higher in the mini group. On multivariable logistic regression and propensity score adjustment, the mini approach was not predictive of a composite outcome of death, CVA, ARF, or re-op for bleeding.

Conclusions
The mini approach is safe for performing aortic surgery in selected patients. It was associated with a higher rate of re-op for bleeding, which may be due to higher proportion of arch procedures. Further series are required to help establish outcomes for this procedure.

Aortic Surgery Forum (Basic Aortic Research, Venue for Residents, Fellows, Junior Attendings)