Ascending aortic aneurysms treated by cuneiform resection and end-to-end anastomosis through a ministernotomy.
BACKGROUND
Ascending aortic aneurysms without dilatation of the sinuses of Valsalva are generally handled by resection and replacement with a tubular graft or by tailoring aortoplasty. We propose an alternative treatment with a direct anastomosis of the two stumps of the aorta after complete aneurysm resection through an upper J ministernotomy.


METHODS
We have applied this procedure to 45 patients. Mean age was 60.2 +/- 12.1 years. Mean aneurysm diameter was 51.0 +/- 8.0 mm. The skin incision averaged 6.5 cm. Two circumferential aortotomies were made: one at the level of the sinotubular junction, the other one just below the innominate artery. The two ends of the aorta were then sutured with a 3-0 Prolene running suture. In 31 cases (61%) aorta-associated valve replacement was carried out.


RESULTS
Hospital mortality was 4.4%. Mean CPB and cross-clamp times were 104 +/- 71 and 68 +/- 25 minutes respectively. Mean blood loss was 380 +/- 300 mL. Median ventilation requirement and intensive care unit stay were 17 and 21 hours. Median hospital stay was 7 days. During the follow-up period (23.7 +/- 12.3 months), 1 patient required reoperation and 2 patients died. Event-free survival is 88.4 +/- 5.7 at 44 months. The surviving patients are routinely checked with ultrasonography and angio computed tomography scan. There was a very low redilatation rate (1 patient, 2.3%) and no incidence of pseudoaneurysm.


CONCLUSIONS
Complete resection of ascending aortic aneurysms with end-to-end anastomosis through an upper ministernotomy represents a feasible, safe, physiologic and cost-effective minimally invasive surgical option in cases of aneurysms with normal or nearly normal sinotubular junctions.
Viganò
Mario
M
Department of Cardiac Surgery, IRCCS Policlinico S. Matteo, University of Pavia, Italy.
Rinaldi
Mauro
M
D'Armini
Andrea M
AM
Boffini
Massimo
M
Zattera
Giuseppe F
GF
Alloni
Alessia
A
Dore
Roberto
R
D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D013249:Sternum / Q000601:surgery; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome