Comparing Outcomes of Sternal-Sparing Aortic Valve Replacement With and Without Concomitant Ascending Aortic Replacement.

Abstract

This study aimed to compare the outcomes of minimally invasive aortic valve replacement (AVR) with or without concomitant ascending aortic and hemiarch replacement. The focus was on assessing the impact of additional ascending aortic procedures on postoperative morbidity and mortality in the context of minimally invasive sternal-sparing surgery. In a retrospective analysis of 796 patients from 2019 to 2024, 2 groups were compared: 624 patients underwent isolated AVR, and 172 underwent combined AVR with proximal ascending aortic and/or hemiarch replacement (AVR+Asc). Among the latter group, 108 patients had a hemiarch replacement with circulatory arrest. The study examined postoperative outcomes, including mortality, stroke rates, and 30-day readmission rates. The median age of the patients was 64 (IQR, 58-72) years, and 25% of the patients were female. Operative times were longer in the AVR+Asc than AVR group, with increased cardiopulmonary bypass (152 vs 93 minutes; P < .001) and cross-clamp (124 vs 69 minutes; P < .001) times. However, no major significant differences were observed in conversion (0.6% vs 0.2%; P = .4), stroke (0.2% vs 0.0%; P = .2) rates between the groups. Intensive care unit stay durations were similar (26 vs 27 hours; P = .2), although hospital stays were longer for the AVR+Asc group (4 vs 3 days; P < .001). The in-hospital mortality rates were slightly higher in the AVR+Asc group (1.2% vs 0.0%; Fisher's P = .046) but did not differ significantly from the isolated AVR group at 5 years (log-rank P = .14). Minimally invasive, sternal-sparing AVR+Asc is associated with longer operative times but does not significantly increase short-term morbidity or mortality compared with isolated AVR. These findings suggest that additional ascending aortic procedures during minimally invasive AVR can be performed without substantially increasing postoperative risks.