Proximal Aortic Surgery: Upper 'J' or Conventional Sternotomy?
| Autor: | Fuat Bilgen, Ayca Ozgen, Hamdi Toköz, Ismail Oral Hastaoglu |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Blood transfusion medicine.medical_treatment Bentall procedure Aortic Diseases 030204 cardiovascular system & hematology law.invention 03 medical and health sciences Young Adult 0302 clinical medicine Aortic valve replacement law medicine Cardiopulmonary bypass Humans Minimally Invasive Surgical Procedures Cardiac Surgical Procedures Aorta Aged Ejection fraction business.industry Perioperative Middle Aged medicine.disease Intensive care unit Sternotomy Cardiac surgery Surgery 030228 respiratory system Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The heart surgery forum. 21(1) |
| ISSN: | 1522-6662 |
| Popis: | Background: While minimally invasive procedures are being used in cardiac surgery, experience with minimally invasive proximal aortic surgery has been limited to certain centers.Methods: Between January 2010 and March 2015, 54 patients with an upper “J” hemi-sternotomy and 75 patients with a conventional sternotomy due to proximal aortic pathology were included in this study. Forty-five patients from the “J” hemi-sternotomy group were matched with 45 patients from the conventional sternotomy group with respect to age, sex, ejection fraction, diabetes, hypertension, smoking history and operative type. Perioperative variables were in-hospital mortality, surgery for revision, amount of blood loss, requirement for blood transfusion, cardiopulmonary bypass (CPB), aortic cross-clamp and unilateral cerebral protection times, duration of ventilation, and length of intensive care unit (ICU) and total hospital stay.Results: Patients were between 21-76 years with a mean age of 58.14 ± 11.06 years; 73.3% (n = 66) were male and 26.7% (n = 24) were female. Of all the cases included, 36.7% (n = 33) had isolated ascending aortic replacement, 41.1% (n = 37) had concomitant aortic valve replacement and ascending aortic replacement, and 22.2% (n = 20) had a Bentall procedure. Statistically, the amount of bleeding (P = .026), length of ventilation (P = .001), ICU (P = .001) and total hospital stay (P = .004) in the “J” hemi-sternotomy group were all found to be significantly lower than those in the conventional group.Conclusions: Minimally invasive techniques like an upper “J” hemi-sternotomy can be safely performed without prolonging the aortic clamp time, and with less blood loss, less ventilatory support, and shorter ICU and total hospital stays when compared to conventional methods. |
| Databáze: | OpenAIRE |
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