Minimally invasive thoracic aortic surgery: Our experience [Chirurgia dell’aorta ascendente e radice aortica con approccio mini-invasivo: la nostra esperienza]

Background. The growing experience in minimally invasive techniques, supported by outstanding outcomes and excellent surgical exposure of the entire proximal thoracic aorta via ministernotomy, has motivated surgeons to apply this approach to more challenging procedures such as aortic root and arch treatment. Methods. From September 2016 to April 2024, 243 consecutive patients underwent proximal aortic surgical treatment through the ministernotomy approach at the Cardiac Surgery Unit of the Lancisi Cardiovascular Center of Ancona- Polytechnic University of Marche, Italy. In all cases, a preoperative computed tomography scan was performed. Results. The mean age of the population was 65 +/- 12 years, and 176 patients (72%) were male. Aortic valve disease occurred in 66.9% of cases (n=85) with significant aortic valve regurgitation or stenosis in 127 (52%) and 44 (18%) patients, respectively. Bicuspid aortic valve was found in 29% of patients (n=70). Surgical procedures included aortic root operations (n=88) using Bentall (n=64) or David (n=24) technique, isolated replacement of the ascending aorta (n=73), and combined treatment: replacement of the ascending aorta and the aortic valve (n=82). The 30-day mortality and stroke rate was 0.4%. In 132 patients (54%), extubation occurred within the first 6 h after surgical treatment. The median hospital stay was 7 days with 48% (n=107) of patients discharged home without need for any cardiac rehabilitation. Conclusions. Minimally invasive thoracic aortic surgery can be performed successfully at specialized cardiac surgery centers. Preoperative careful and accurate analysis of patient's computed tomography scan is essential to promote patient-tailored planning and promote optimal surgical exposure.