title: Minimally invasive aortic root replacement: a bridge too far?
abstract: OBJECTIVE
  Minimally invasive aortic valve surgery has been studied widely with outcomes comparable or better than standard sternotomy. We recently reported on decreased blood loss, cross clamp time and length of hospital stay when compared to conventional full sternotomy. We expanded the indication to aortic root surgery and report here our 8 years experience.
  
  
  METHODS
  From December 1997 to November 2005, 35 patients (mean age 51.3+/-15 years) underwent aortic root replacement, through a partial upper J-sternotomy. A homograft was implanted in 26 (74.3%) patients; the remainder received a valved (4 bioprosthesis, 5 mechanical) conduit. Mean preoperative euroscore was 7+/-2.7 and mean predicted mortality was 11.5+/-13.8%. Mean and median follow-up time was 51+/-31 and 66 months, respectively.
  
  
  RESULTS
  Mean aortic cross clamp and cardiopulmonary bypass time were 126+/-25 and 182+/-61 min respectively. Revision for bleeding was necessary in 1 (2.9%) patient. Mean extubation time was 10.4+/-4.8 hours. No postoperative strokes occurred. Intensive care unit stay ranged from 1 to 42 days (2.7+/-7.4 days, median 1). There were 3 (8.5%) early deaths (sepsis, multi-organ failure and low cardiac output) and 2 late non-cardiac deaths. Hospital morbidity included acute renal failure (n=3), pacemaker implantation (n=3), and prolonged ventilation (n=3). Eleven (31.4%) patients experienced atrial fibrillation. No other reoperations were performed. Actuarial survival at 99 months was 74.4% (n=30).
  
  
  CONCLUSIONS
  Our results indicate that minimally invasive aortic root replacement is a challenging but feasible procedure with a lower observed mortality than predicted mortality. We continue to perform this procedure in good risk patients.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Bakir
authors.forename: F
authors.initials: F
authors.lastname: Casselman
authors.forename: R
authors.initials: R
authors.lastname: De Geest
authors.forename: F
authors.initials: F
authors.lastname: Wellens
authors.forename: L
authors.initials: L
authors.lastname: Foubert
authors.forename: I
authors.initials: I
authors.lastname: Degrieck
authors.forename: F
authors.initials: F
authors.lastname: Van Praet
authors.forename: Y
authors.initials: Y
authors.lastname: Vermeulen
authors.forename: H
authors.initials: H
authors.lastname: Vanermen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve; D002315:Cardiopulmonary Bypass; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D017060:Patient Satisfaction; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome