Complex aortic surgery shown safe with minimally invasive approach

Editor's Note

Minimally invasive surgery can extend beyond valve replacement to complex aortic procedures without sacrificing safety or long-term outcomes. According to an August 21 news update from the University of Miami Miller School of Medicine, a new study of 796 patients found adding ascending aortic or hemiarch replacement to minimally invasive aortic valve replacement (AVR) produced excellent 5-year survival rates of 98.8%, with low complication rates.

As detailed in the article, the research—led by cardiovascular and thoracic surgeon Joseph Lamelas, MD, and quality management analyst Ahmed Alnajar, MD, MSPH—analyzed outcomes from 2019 to 2024, all performed by Dr Lamelas using a right mini-thoracotomy approach. Of the patients studied, 624 underwent isolated AVR while 172 had AVR combined with ascending aortic and/or hemiarch replacement (AVR+Asc). Researchers compared OR time, ICU and hospital stay, stroke, in-hospital and 5-year mortality, and readmissions.

AVR+Asc cases were more complex and required significantly longer cross-clamp and cardiopulmonary bypass times. Yet conversion to open sternotomy occurred in only one patient from each group. In-hospital mortality was just 1.2% in the AVR+Asc group and zero for isolated AVR, while stroke occurred in only one patient undergoing combined surgery. According to the article, infectious complications such as pneumonia and sepsis remained rare and similar across groups. Blood transfusion needs were higher for AVR+Asc patients, but nearly 80% avoided red blood cell transfusion, reflecting reduced tissue trauma with the mini-thoracotomy approach. Thirty-day readmission was slightly higher in the combined surgery group (5.8% vs 2.1%), though rates were still low and not tied to major complications.

The study highlights minimally invasive AVR with ascending aortic or hemiarch replacement is both feasible and safe, expanding the role of this approach for higher-risk patients. Patient feedback reinforced the clinical results, per the outlet. Many expressed gratitude for shorter recovery times and the ability to return to active lives. Dr Lamelas emphasized even complex root or hemiarch cases can be performed safely through a sternotomy-sparing approach in the hands of highly experienced surgeons, while Dr Alnajar noted the importance of offering the least-invasive surgical option without compromising durability.