Purpose: Traditionally, a median sternotomy platform is utilized for ascending aorta and hemiarch replacement. We aimed to assess the effectiveness of a minimally invasive approach via right thoracotomy in patients undergoing replacement of the ascending aorta and hemiarch under circulatory arrest and retrograde cerebral perfusion. Methods: From 2017-23, 109 patients underwent ascending aortic and hemiarch replacement with circulatory arrest via a minimally invasive approach. The operative times, intensive care unit and hospital lengths of stay, postoperative outcomes, as well as midterm mortality, were analyzed. Results: The median age was 62 years (IQR:54-68) and 73% were female. Reduced ejection fraction < 40 was seen in 11%. The aortic valve was bicuspid in most patients (69%) and 12% had a prior aortic valve replacement. Most patients underwent elective surgery (94%). The median aortic cross-clamp and cardiopulmonary bypass times were 139 [114-188] minutes and 166 (146-188) minutes, respectively. The median hypothermic circulatory arrest time was 32 (30-34) minutes. Concomitant replacement of the aortic valve was required in 44% (n=48), while hemiarch with only mitral valve repair was required in 5.5% of the cohort (n=6). There was no in-hospital mortality. Post-operative stroke accounted for 1.8% of patients (n=2). The median intensive care unit and hospital lengths of stay were 24 (IQR, 24-24) hours and 4 (3-5) days, respectively. 30-Day readmission accounted for 8.3% of patients. Thirty-three patients completed 1-year follow up with zero mortality. At a maximum follow-up time of 65 months (5 years), 1 patient died at the 13-month follow up. Conclusion: Minimally invasive ascending aorta and hemi-arch replacement via a right anterior thoracotomy approach can be consistently performed with low morbidity and mortality in surgeons experienced in lesser invasive approaches. This technique is safe and less invasive, which enables a quicker recovery. Our 5-year survival of 99% compares favorably to a recent study of sternotomy-based approach of 84%. A head-to-head comparison with a comparable cohort that underwent mid-sternotomy is warranted.
Identify the source of the funding for this research project: NA
