Short-term outcomes in upper-hemi sternotomy for ascending and hemi-arch aortic repair with and without concomitant aortic valve replacement or repair

Abstract

Introduction

Full median sternotomy is the traditional operative approach for ascending aortic aneurysm repair. Minimally invasive approaches are being used more frequently by surgeons to enhance recovery.

Methods

This is a single-institution, multi-surgeon retrospective review of adult patients who underwent elective aneurysm surgery involving the ascending aorta and proximal arch between 1 January 2015 and 30 June 2024 with and without aortic valve replacement/repair. Exclusion criteria included re-operation, aortic root procedure, and other concomitant valve procedure or coronary artery bypass grafting. Operative and short-term clinical outcomes were compared between patients undergoing upper hemi-sternotomy (UHS) and full median sternotomy (FMS).

Results

Among 166 patients in the analysis dataset, 84 (50.6%) underwent FMS and 82 (49.4%) underwent UHS. UHS and FMS groups had similar median cardiopulmonary bypass time (129 vs. 137 min, p = 0.436) and median aortic cross-clamp time (92 vs. 96.5 min, p = 0.900). Patients undergoing UHS were more likely to be discharged home (93.9% vs. 83.3%, p = 0.032) and had a shorter length of stay (5 vs. 6 days, p < 0.001) compared to FMS. 30-day mortality occurred in one patient (1.2%) in the FMS group.

Conclusions

Elective aneurysm repair can be performed safely with less invasive hemi-sternotomy approaches. Minimally invasive approaches enhance recovery after surgery. Future prospective studies are needed to clarify potential benefits in postoperative pain and quality of life.