Isolated or Combined Ascending Aortic Replacement through a Partial Sternotomy: Early and Midterm Outcomes

Abstract

Background We aimed to investigate the in-hospital and midterm outcomes of patients undergoing ascending aortic replacement (AAR) through a partial or a full sternotomy approach through a propensity matching analysis.

Methods We retrospectively included all patients (n = 167) who underwent elective AAR in our institution between 2013 and 2020. The study population was divided into two groups according to the surgical access (40 patient in the partial sternotomy or “PS” group and 127 in the full sternotomy or “FS” group). Due to the significant differences between the groups, a propensity matching of 1:3 was applied. In-hospital complications, survival, and reoperation at follow-up were investigated.

Results The PS group showed higher cross-clamp and cardiopulmonary bypass times than the FS group (94.2 vs. 83 minutes and 164.2 vs. 126.8 minutes, respectively). Moreover, the postoperative ventilation time was significantly higher in the PS group, but it did not affect the length of stay in the intensive care unit (ICU). The incidences of bleeding, stroke, and mortality were comparable between the two groups (11 vs. 3%, 3 vs. 6%, and 5 vs. 3%, respectively). After a median follow-up of 2 ± 1.98 years, the Kaplan–Meier analysis showed no significant differences between the two groups (log-rank, p = 0.17) in terms of survival.

Conclusion The surgical ascending aorta replacement through a partial sternotomy is associated with longer operative times, but this does not affect the early as well as the long-term follow-up.

Keywords

minimally invasive surgery - aorta/aortic - aneurysm

Note

A part of the present study was performed in fulfilment of the requirements for obtaining the doctoral degree of M. Angerer.

Ethical Approval Statement

This study was approved by the hospital study center (SZ_D_159.21-I-6) and institutional review board of the Paracelsus Medical University–Campus Nuremberg (IRB-2022–015) and was conducted in accordance with the principles of the Declaration of Helsinki. A written consent was obtained from all patients for the anonymous use of in-hospital data, while a verbal consent was obtained for the telephonic follow-up.

Authors' Contribution

M.A. contributed to data collection and validation, interpretation of data, drafting of the manuscript. F.P. contributed to conception and design, data collection and validation, interpretation of data, drafting of the manuscript. W.H. contributed to statistical analysis and interpretation of data. L.W. contributed to data collection and revising of the manuscript. J.S. contributed to data collection and revising of the manuscript. T.F. contributed to critical revision of the manuscript.

^* These authors contributed equally and are first author.

Publication History

Received: 05 September 2023

Accepted: 02 February 2024

Article published online:
16 April 2024

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