Leontyev S. , Pinot J. , Borger M. A.
Heart Center Leipzig;ABSTRACT BODY: Objective(s): Minimally invasive surgical (MIS) approaches to valvular heart disease have become more routine within the last decade. However, the outcomes of MIS for thoracic aortic surgery remain unclear. The aim of this retrospective study was to review our techniques and outcomes with MIS for proximal thoracic aortic operations. Methods: From 1996-2011, 199 patients underwent proximal thoracic aortic operations via an upper hemi-sternotomy (L-, J- or T-incision). 146/199 (73.4%) underwent ascending aortic, 52/199 (26.1%) ascending aortic and arch, and 1/199 (0.5%) isolated aortic arch (0.5%) operations, with 59.7% receiving a modified Bentall procedure. The mean age was 55.1+/-14 years and 30.7% were female. Mean follow-up (98% complete) was 5.1+/-3.6 years (33 days-14.4 years). Results: The 30-day mortality was 5.0%. The conversion rate to full sternotomy was 2% (n=4). The most common complications were reoperation for bleeding (11.6%), respiratory failure (5.5%), stroke (3.5%) and mediastinitis (1%). The mean hospital stay was 12+/-10 days. The dependent predictors for 30 day mortality were arterial hypertension, reduced left ventricular ejection fraction (LVEF) [<45%], diabetes and COPD. The only independent predictor for 30 day mortality was reduced LVEF. The estimated 10-year survival was 74% and freedom from aortic-related reoperation was 93.5%. Conclusions: Proximal thoracic aortic operations via upper hemi-sternotomy are associated with acceptable early outcomes. The procedure is safe, with very low conversion rate. Follow-up results reveal good mid-term survival and freedom from aortic reoperation, indicating that this is a reasonable approach for selected patients.