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Hamiko M, Salamate S, Nassari MA, Spaeth A, Sirat S, Doss M, Amer M, Silaschi M, Ahmad AES, Bakhtiary F. Totally Endoscopic Replacement of the Ascending Aorta and the Aortic Root including the Aortic Valve via Right Mini-Thoracotomy: A Multicenter Study. J Clin Med 2024; 13:2648. [PMID: 38731177 PMCID: PMC11084888 DOI: 10.3390/jcm13092648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Recently, minimally invasive access via right anterolateral mini-thoracotomy (RAMT) has been gaining popularity in cardiac surgery. This approach is also an option for surgeons performing aortic surgery. The aim of this study is to present our surgical method, highlighting the total endoscopic minimally invasive approach via RAMT for replacement of the ascending aorta (AAR) with or without involvement of the aortic root and the aortic valve. Methods: Clinical data of 44 patients from three participating institutions with AAR with or without involvement of the aortic valve or aortic root via RAMT between April 2017 and February 2024 were retrospectively analyzed. According to surgical procedure, patients were divided into two groups, in the AAR and in the Wheat/Bentall group with concomitant valve or root replacement. Operative time, length of ventilation, perioperative outcome, length of intensive care unit (ICU) as well as postoperative hospital stay, and mid- and long-term results were retrospectively analyzed. Results: Mean age was 61.4 ± 10.7 years old with a frequency of male gender of 63.6%. Mean cardiopulmonary bypass (CBP) time and aortic cross-clamping time was 94.9 ± 32.5 min and 63.8 ± 25.9 min, respectively. CPB and aortic clamp time were significantly lower in AAR group. In the first 24 h, the mean drainage volume was 790.3 ± 423.6 mL. Re-thoracotomy due to bleeding was zero. Sternotomy was able to be avoided in all patients. Patients stayed 35.9 ± 23.5 h at ICU and were discharged 7.8 ± 3.0 days following surgery from hospital. Mean ventilation time was 5.8 ± 7.6 h. All patients survived and 30-day mortality was 0.0%. At a median follow-up time of 18.2 months, all patients were alive. The results were similar in both groups. Conclusions: The full endoscopic RAMT approach with 3D visualization is a safe, feasible and promising technique that can be transferred in the field of aortic surgery without compromising surgical quality, postoperative outcomes, or patient safety when performed by an experienced team in a high-volume center.
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Affiliation(s)
- Marwan Hamiko
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (S.S.); (M.A.N.); (A.S.); (M.S.); (A.E.-S.A.); (F.B.)
| | - Saad Salamate
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (S.S.); (M.A.N.); (A.S.); (M.S.); (A.E.-S.A.); (F.B.)
| | - Maedeh Ayay Nassari
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (S.S.); (M.A.N.); (A.S.); (M.S.); (A.E.-S.A.); (F.B.)
| | - Andre Spaeth
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (S.S.); (M.A.N.); (A.S.); (M.S.); (A.E.-S.A.); (F.B.)
| | - Sami Sirat
- Department of Cardiac Surgery, Helios Hospital Siegburg, 53721 Siegburg, Germany; (S.S.); (M.D.)
| | - Mirko Doss
- Department of Cardiac Surgery, Helios Hospital Siegburg, 53721 Siegburg, Germany; (S.S.); (M.D.)
| | - Mohamed Amer
- Department of Cardiac Surgery, Helios Hospital Wuppertal, 42283 Wuppertal, Germany;
| | - Miriam Silaschi
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (S.S.); (M.A.N.); (A.S.); (M.S.); (A.E.-S.A.); (F.B.)
| | - Ali El-Sayed Ahmad
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (S.S.); (M.A.N.); (A.S.); (M.S.); (A.E.-S.A.); (F.B.)
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (S.S.); (M.A.N.); (A.S.); (M.S.); (A.E.-S.A.); (F.B.)
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Song C, Jiang S. Supplement to right anterior mini-thoracotomy approach for isolated aortic valve replacement. J Card Surg 2021; 37:1125. [PMID: 34842311 DOI: 10.1111/jocs.16170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Chao Song
- Medical School of Chinese PLA, Beijing, China.,Department of Cardiovascular Surgery, The First Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Shengli Jiang
- Department of Cardiovascular Surgery, The First Medical Centre of Chinese PLA General Hospital, Beijing, China
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