title: Minimally Invasive Aortic Root Replacement with Valved Conduits through Partial Upper Sternotomy.
abstract: Minimally invasive surgical access through limited sternotomy reduces trauma and morbidity in cardiosurgical patients. However, until now, it is not the standard access for aortic root replacement. This study details our clinic's experience with minimally invasive implantation of valved conduits through partial upper sternotomy and the comparison to conventional full median sternotomy.
  
  
  
  Between January 2012 and March 2016, a total of 187 patients underwent aortic root replacement with valved conduits in our department. Minimally invasive access through partial upper sternotomy (group A) was performed in 33 patients (9 female, 24 male; mean age: 55.68 ± 13.24 years). Four of these patients received concomitant mitral and tricuspid valve interventions. The results were compared with similar procedures through conventional approach (group B): 25 patients (7 female, 18 male; mean age: 59.09 ± 12.32 years).
  
  
  
  In all 33 cases of minimally invasive access and 25 cases of conventional approach, aortic root replacement was successful. Operative times were as follows (in minutes; groups A and B)-cardiopulmonary bypass: 166.12 ± 40.61 and 162.88 ± 45.89; cross-clamp time: 122.24 ± 27.42 and 113.44 ± 22.57, respectively. In both groups, two patients needed postoperative reexploration due to secondary bleeding. One multimorbid patient suffered from postoperative stroke and died on the ninth postoperative day due to heart failure. The observed operation times and clinical results after minimally invasive surgery are comparable to conduit implantation through full median sternotomy.
  
  
  
  Partial upper sternotomy is a feasible access for safe aortic root replacement with valved conduits. Nevertheless, minimally invasive aortic root replacement is a challenging operative procedure.
authors.affiliation: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Universitatsklinikum Münster, Münster, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Hillebrand
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Universitatsklinikum Münster, Münster, Germany.
authors.forename: Mosab
authors.initials: M
authors.lastname: Alshakaki
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Universitatsklinikum Münster, Münster, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Martens
authors.affiliation: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Universitatsklinikum Münster, Münster, Germany.
authors.forename: Mirela
authors.initials: M
authors.lastname: Scherer
mesh_terms: D000328:Adult; D000368:Aged; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D002315:Cardiopulmonary Bypass; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D019106:Postoperative Hemorrhage / Q000601:surgery; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods*; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome