title: Minimal-access aortic valve replacement with concomitant aortic procedure: a 9-year experience.
abstract: OBJECTIVE
  Minimal-access approaches through upper hemisternotomy is an established technique for aortic valve replacement (AVR) and aortic surgery in our institution. We assessed the outcome of undergoing AVR with concomitant aortic surgery through upper hemisternotomy.
  
  
  METHODS
  We retrospectively reviewed 109 patients from January 2002 to May 2011 who had AVR with concomitant aortic surgery through upper hemisternotomy. Aortic valve replacement with supracoronary ascending aortic replacement was performed in 65 patients; AVR with ascending and proximal arch replacement, in 8 patients; AVR with aortoplasty, in 11 patients; Bentall procedure, in 8 patients; and AVR with root enlargement, in 13 patients. In-hospital outcomes and 1- and 5-year survival were examined.
  
  
  RESULTS
  The mean age was 58.5 years (range, 23-89 years); 41.3% of patients had bicuspid aortic valve (n = 45). Of the patients, 82.6% had true aneurysm (n = 90), 2.8% had calcified aorta (n = 3), 8.3% had small annulus (n = 9), and 3.7% had calcified annulus (n = 4). There were 6 (5.5%) reoperations and 15 (13.8%) urgent cases. Mean perfusion time was 152 ± 61 minutes, and cross-clamp time was 108 ± 47 minutes. Nine cases were performed with deep hypothermic circulatory arrest (8.3%). Operative mortality was 2.8% (n = 3). There were 4 (3.7%) cases with reoperation for bleeding, 2 (1.8%) myocardial infarctions, and 2 (1.8%) new-onset renal failure. Mean length of stay was 7.1 ± 5.6 days. Kaplan-Meier analysis showed that 1-year postoperative survival was 96.2% and 5-year survival was 92.4%.
  
  
  CONCLUSIONS
  An upper hemisternotomy approach is safe and feasible for AVR and concomitant aortic surgery with good early and midterm outcomes. This approach is also associated with low morbidity rate and short length of stay.
authors.affiliation: Department of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kaneko
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Couper
authors.forename: Wernard A A
authors.initials: WA
authors.lastname: Borstlap
authors.forename: Foeke J H
authors.initials: FJ
authors.lastname: Nauta
authors.forename: Laurens
authors.initials: L
authors.lastname: Wollersheim
authors.forename: Siobhan
authors.initials: S
authors.lastname: McGurk
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Cohn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000150:complications / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods*; D013997:Time Factors; D055815:Young Adult