Mini Bentall operation: technical considerations

Eusanio, Marco Di; Cefarelli, Mariano; Zingaro, Carlo; Capestro, Filippo; Matteucci, Sacha; D’Alfonso, Alessandro; Pierri, Michele D.; Aiello, Marco; Berretta, Paolo

doi:10.1007/s12055-018-0669-4

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…All procedures were performed under general anesthesia. Our MS technique to access proximal aortic pathology has been previously described 7 . Briefly, after a 5–6 cm midline skin incision, a right‐sided J‐shaped or a left‐sided L‐shaped MS extended into the fourth intercostal space was performed.…”

Section: Methodsmentioning

confidence: 99%

“…Our MS technique to access proximal aortic pathology has been previously described. 7 Briefly, after a 5-6 cm midline skin incision, a right-sided J-shaped or a left-sided L-shaped MS extended into the fourth intercostal space was performed. Cardiopulmonary bypass (CPB) was instituted using a central arterial cannulation site (distal ascending aorta or aortic arch), axillary artery, brachiocephalic trunk, or femoral artery, as indicated.…”

Section: Surgical Techniquementioning

confidence: 99%

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Comparison of minimally invasive versus conventional thoracic aortic operations: Early and midterm results in a series of 624 patients

Berretta

Chiuselli

Galeazzi

et al. 2022

Journal of Cardiac Surgery

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Objective Despite minimally invasive techniques having gained wider application in cardiac surgery, current evidence on minithoracic aortic surgery is still limited. The aim of this study was to compare early and midterm outcomes of patients undergoing operations of the proximal thoracic aorta through ministernotomy (MS) versus full sternotomy (FS). Methods Data from 624 consecutive patients who underwent proximal aortic repair through MS (n = 214, 34.3%) and FS (n = 410, 65.7%) at two aortic centers were analyzed. Treatment selection bias was addressed using propensity score matching (MS vs. FS). After matching, two well‐balanced groups of 202 patients each were created. Results Median cardiopulmonary bypass and cross‐clamp times were 88 and 68 min, respectively, with no difference between groups. Overall, 30‐day mortality was 1% (n = 2) in MS and 0.5% (n = 1) in FS (p = .6). No difference was found in the rates of stroke (MS n = 5, 2.5%; FS n = 5, 2.5%), dialysis (MS n = 1, 0.5%; FS n = 4, 2%), bleeding (MS n = 7, 3.5%; FS n = 7, 3.5%), and blood transfusions (MS n = 67, 33.3%; FS n = 57, 28.4%). Patients receiving MS showed a lower incidence of respiratory insufficiency compared with FS (0% vs. 2.5%, p = .04). Intensive care unit and hospital stays were similar between groups. Two‐year survival rate was 97.2% in MS and 96.5% in FS (p = .9). Conclusions Mini proximal aortic operations can be performed successfully without compromising the proven efficacy and safety of conventional access. In selected patients, MS was associated with very low mortality and morbidity rates. Additionally, MS demonstrated superior clinical outcomes as regards respiratory adverse events, when compared with FS.

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Section: Methodsmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Comparison of minimally invasive versus conventional thoracic aortic operations: Early and midterm results in a series of 624 patients

Berretta

Chiuselli

Galeazzi

et al. 2022

Journal of Cardiac Surgery

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“…The technical aspects of the minimally invasive Bentall operations have been published by Di Eusanio et al [15]. Our approach and surgical setup are similar, with some exceptions listed below.…”

Section: Surgical Techniquementioning

confidence: 98%

The Feasibility of Less-Invasive Bentall Surgery: A Real-World Analysis

van Kampen,

Etz,

Haunschild

et al. 2023

Life

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Objective: Minimally invasive approaches are being used increasingly in cardiac surgery and applied in a wider range of operations, including complex aortic procedures. The aim of this study was to examine the safety and feasibility of a partial upper sternotomy approach for isolated elective aortic root replacement (a modified Bentall procedure). Methods: We performed a retrospective analysis of 768 consecutive patients who had undergone isolated Bentall surgery between January 2000 and January 2021 at our institution, with the exclusion of re-operations, endocarditis, acute aortic dissections, and root replacement with major concomitant procedures such as multi-valve or coronary bypass surgery. A total of 98 patients were operated on via partial sternotomy (PS) and were matched 2:1 to 196 patients operated on via full sternotomy (FS). Results: The procedure time was 12 min longer in the PS group (205 min vs. 192.5 min in the FS group, p = 0.002), however, cardiopulmonary bypass and aortic cross-clamp times were comparable between groups. Eight PS-procedures were converted to full sternotomy, predominantly for bleeding complications (n = 6). Re-exploration for acute bleeding was necessary in 11% of the PS group and 4.1% of the FS group (p = 0.02). Five FS patients and none in the PS group required emergency coronary bypass grafting for postoperative coronary obstruction (p = 0.2). PS patients were hospitalized for a significantly shorter period (9.5 days vs. 10.5 days in the FS group, respectively). There were no significant differences regarding in-hospital (p = 0.4) and mid-term mortality (p = 0.73), as well as for other perioperative complications. Conclusions: Performing Bentall operations via partial upper sternotomy is associated with similar perfusion and cross-clamp times, as well as overall mortality, when compared to a full sternotomy approach. A low threshold for conversion to full sternotomy should be accepted if limited access proves insufficient for the handling of intraoperative complications, particularly bleeding.

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“…Using MS, aortic repair is performed in the same manner as a standard sternotomy access. Indeed visualization is similar to a full sternotomy, and no specialized techniques or equipment are required to perform the well-established operations of the ascending aorta and aortic root (Bentall [4], valve sparing [5], supracoronary ascending aorta replacement) (Fig. 2, Video 1) as well as of the aortic arch (hemiarch replacement [6] or total arch replacement with an elephant trunk or frozen elephant trunk construction [7,8]).…”

Section: Upper Msmentioning

confidence: 99%

Minimally invasive approach: is this the future of aortic surgery?

Berretta

Galeazzi

Cefarelli

et al. 2021

Indian J Thorac Cardiovasc Surg

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Median sternotomy incision has shown to be a safe and efficacious approach in patients who require thoracic aortic interventions and still represents the gold-standard access. Nevertheless, over the last decade, less invasive techniques have gained wider clinical application in cardiac surgery becoming the first-choice approach to treat heart valve diseases, in experienced centers. The popularization of less invasive techniques coupled with an increased patient demand for less invasive therapies has motivated aortic surgeons to apply minimally invasive approaches to more challenging procedures, such as aortic root replacement and arch repair. However, technical demands and the paucity of available clinical data have still limited the widespread adoption of minimally invasive thoracic aortic interventions. This review aimed to assess and comment on the surgical techniques and the current evidence on mini thoracic aortic surgery.

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Mini Bentall operation: technical considerations

Cited by 4 publications

References 21 publications

Comparison of minimally invasive versus conventional thoracic aortic operations: Early and midterm results in a series of 624 patients

Comparison of minimally invasive versus conventional thoracic aortic operations: Early and midterm results in a series of 624 patients

The Feasibility of Less-Invasive Bentall Surgery: A Real-World Analysis

Minimally invasive approach: is this the future of aortic surgery?

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