P131. Expanding the Minimally Invasive Approach for Replacement of the Ascending Aorta towards the Proximal Aortic Arch
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Hannover Medical School(MHH)
Hannover
Germany - Contact Me
I am currently working as a cardiothoracic surgery resident and member of the "HTTG aortic team" at the Clinic for Cardiothoracic-, Transplantation-, and Vascular Surgery, Hannover Medical School, Lower Saxony, Germany. Additionally, I work as group leader in the vascular tissue engineering working group at the Lower Saxony Center for Biomedical Engineering, Implant Research and Development, Lower Saxony, Germany.
I finished basic medical training at Hannover Medical School in 2015 and obtained my medical doctorate degree at the Hannover Biomedical Research School in 2022.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
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.
Authors
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)
Institutions
(1) Hannover Medical School, Hannover, Lower Saxony, Germany
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.
Authors
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)
Institutions
(1) Hannover Medical School, Hannover, Lower Saxony, Germany
Presentation Duration
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