Aortic root replacement by ministernotomy: technique and potential benefit

Background. Although minimally invasive surgical procedures have aroused much interest in cardiac surgery, difficulty still exists with its application in most of the operations on great arteries. This report summarizes our initial experience of aortic root replacement by a superior ministernotomy in terms of operative indications, operative techniques, and potential benefits. Methods. Between July 1999 and September 1999, 8 patients who were diagnosed with Marfan syndrome with aortic valve regurgitation underwent aortic root replacements with composite grafts. Clinical characteristics, in-hospital outcomes, and postoperative stay of these patients were compared with data of patients who had undergone Bentall procedure by standard median sternotomy from January to September 1999. Results. There was no death in either group of patients. Demographics were similar between the two groups of patients. In the mini-incision group, the mediastinal drainage was significantly less than the standard incision group. The mean operating time was significantly longer than that in the standard incision group. The cardiopulmonary bypass time and aortic cross-clamping time were similar in both groups of patients. The mean intubation time, postoperative blood transfusion amount, duration of intensive care unit stay and postoperative hospital stay were less than that of the standard incision group; however, they all showed no statistical significant difference. Conclusions. Aortic root replacement by a superior ministernotomy in cardiopulmonary bypass with cannulas through the femoral artery and femoral vein or right atrium is a safe, reliable procedure with excellent exposure. The procedure provides a potential benefit of less trauma, quick recovery, and reduction of mediastinal drainage and reduction of blood transfusion.