title: Progress in ascending and aortic arch surgery: minimally invasive surgery, blood conservation, and neurological deficit prevention.
abstract: BACKGROUND
  Herein are described recent developments in aortic surgery techniques and the improved results.
  
  
  METHODS
  Of 403 ascending and aortic arch operations, 68 patients underwent minimally invasive aortic surgery including 23 for aortic dissection, 5 for Marfan syndrome, 29 reoperations, and 39 with hypothermic arrest. Blood conservation methods were used in 187 of the 403 patients (46.5%). Aortic valve procedures were used in 267 (66.2%), including 51 (12.7%) valve-preserving operations. A protocol for stroke and neurocognitive deficit prevention was used in an attempt to prevent neurologic deficits. Data were prospectively collected and included new neurocognitive events either by formal testing (n = 35) or by informal questioning.
  
  
  RESULTS
  Stroke occurred in 2.0% (8 of 403); clinical gross neurocognitive deficits in 2.5% (10 of 403) with a 98% 30-day survival. For those patients undergoing the minimally invasive operation 1 hospital death occurred (98.5% survival). Homologous operative transfusions were required in only 12% of blood conservation patients (23 of 187) and their postoperative intubation time, intensive care unit (ICU) stay, and hospital stay were significantly shorter (p < 0.04).
  
  
  CONCLUSIONS
  Minimally invasive surgery is particularly useful for reoperations. The blood conservation methods appear to be beneficial and the number of neurologic deficits is low with the current protocol.
authors.affiliation: Center for Aortic Surgery and Marfan Syndrome and Connective Tissue Disorder Clinic, The Cleveland Clinic Foundation, Ohio 44195, USA. svenssl@ccf.org
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
mesh_terms: D000784:Aortic Dissection / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D001804:Blood Transfusion, Autologous; D001925:Brain Damage, Chronic / Q000517:prevention & control*; D002545:Brain Ischemia / Q000517:prevention & control*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D009460:Neurologic Examination; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D020521:Stroke / Q000517:prevention & control