Perioperative outcomes of minimally invasive aortic arch reconstruction with branched grafts through a partial upper sternotomy

Abstract Objectives Ministernotomy has been advocated over recent years as an alternative technique for different cardiovascular surgical procedures in order to reduce the surgical trauma associated with conventional full sternotomy. In recent years, several reports have addressed minimally invasive approaches to the proximal aorta and aortic arch through a partial upper sternotomy (PUS). We reviewed our experience of minimally invasive open aortic arch reconstruction with a branched graft through a PUS Methods Between February 2016 and December 2018, 22 patients underwent open arch repair through a partial upper sternotomy. Moderate hypothermic circulatory arrest and antegrade selective cerebral perfusion were used for organ protection. Median patient age was 76 years (range 65-86). Renal insufficiency was observed in 14 patients (64%) and chronic lung disease in 11 (50%). Total arch replacement was performed in 20 patients (91%), while the remaining 2 (9%) received partial arch replacement with reconstruction of two supraaortic vessels. Aortic valve replacement with a tissue valve or aortic valve repair were each performed concomitantly in one patient (5%) as a concomitant procedure. The median durations of cardiopulmonary bypass, aortic cross-clamping and circulatory arrest were 214, 109 and 50 minutes, respectively. Results No early deaths, permanent neurological deficits or spinal cord injuries occurred. One patient (5%) required intraoperative conversion to full sternotomy due to bleeding caused by a venting cannula injury. Three patients (14%) required re-exploration due to bleeding. Prolonged ventilation occurred in 2 patients (9%) with severe chronic obstructive pulmonary disease. Conclusions Minimally invasive aortic arch reconstruction with branched grafts through a PUS can be safely performed with satisfactory perioperative outcomes.