title: Minimal access aortic surgery including re-operations.
abstract: OBJECTIVE
  Safety and benefits of minimal access ascending aorta and aortic arch surgery, including for re-operations has not been reported.
  
  
  METHODS
  Fifty-four patients undergoing minimal access operations were evaluated. Of the 54 patients, valve replacements were performed in 76% (41 patients) (including composite valve grafts), and re-operations in 33% (18 patients). Composite valve grafts were used in 28% (15 patients) patients, and elephant trunk type procedures in 6% (three patients).
  
  
  RESULTS
  The survival rate was 96% (52 patients), stroke 3.7% (two patients), and neurocognitive deficit 1.8% (one patient). The circulatory arrest time was 20 min (SD 17), aortic crossclamp time 91 min (SD 45) and cardiopulmonary bypass time 132 min (SD 59). Intraoperative homologous blood transfusion was a mean of 1.3 units (SD 2.3). ICU and postoperative stay were 1.8 days (SD 1.9) and 6.7 days (SD 3.7), respectively. No patient died after re-operation, although one patient had a stroke.
  
  
  CONCLUSIONS
  Minimal access aortic surgery does not appear to carry a greater risk and, although more demanding technically, is associated with a reasonable ICU and hospital stay. For re-operations, we particularly recommend the technique.
authors.affiliation: Center for Aortic Surgery, Lahey Clinic, MA, Burlington, USA. lars.g.svensson@lahey.org
authors.forename: L G
authors.initials: LG
authors.lastname: Svensson
authors.forename: E M
authors.initials: EM
authors.lastname: Nadolny
authors.forename: W A
authors.initials: WA
authors.lastname: Kimmel
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D002315:Cardiopulmonary Bypass; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome