Ascending aortic aneurysm treated by cuneiform resection and end-to-end anastomosis through a ministernotomy

BACKGROUND: Ascending aortic aneurysms without dilatation of the sinuses of Valsalva are generally handled by resection and replacement with a tubular graft or by tailoring aortoplasty. We propose an alternative treatment with a direct anastomosis of the two stumps of the aorta after complete aneurysm resection through an upper J ministernotomy.

PATIENTS AND METHODS: We have applied this procedure to 45 patients. Mean age was 60.2 +/- 12.1 years. Mean aneurysm diameter was 51.0 +/- 8.0 mm. The skin incision averaged 6.5 cm. Two circumferential aortotomies were made: one at the level of the sinotubular junction, the other one just below the innominate artery. The two ends of the aorta were then sutured with a 3-0 Prolene running suture. In 31 cases (61%) aorta-associated valve replacement was carried out.

RESULTS: Hospital mortality was 4.4%. Mean CPB and cross-clamp times were 104 +/- 71 and 68 +/- 25 minutes respectively. Mean blood loss was 380 +/- 300 mL. Median ventilation requirement and intensive care unit stay were 17 and 21 hours. Median hospital stay was 7 days. During the follow-up period (23.7 +/- 12.3 months), 1 patient required reoperation and 2 patients died. Event-free survival is 88.4 +/- 5.7 at 44 months. The surviving patients are routinely checked with ultrasonography and angio computed tomography scan. There was a very low redilatation rate (1 patient, 2.3%) and no incidence of pseudoaneurysm.

CONCLUSIONS: Complete resection of ascending aortic aneurysms with end-to-end anastomosis through an upper ministernotomy represents a feasible, safe, physiologic and cost-effective minimally invasive surgical option in cases of aneurysms with normal or nearly normal sinotubular junctions.