The Learning Curve of Total Arch Replacement via Single Upper Hemisternotomy Approach in Aortic Dissection

Abstract

Lin Xia,1,* Yu Liu,1,* Zhonglu Yang,1 Yuguang Ge,1 Lu Wang,1 Yejun Du,1 Yinan Dong,2 Hui Jiang1 1Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, 110016, People’s Republic of China; 2Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning Province, 110016, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hui Jiang, Department of Cardiovascular Surgery, General Hospital of Northern Theater, Command, 83 Wenhua Road, Shenyang, Liaoning Province, 110016, People’s Republic of China, Tel [phone], Fax [phone], Email [email protected]: Upper hemisternotomy (UHS) has benefits over conventional full sternotomy because it ameliorates trauma during cardiac surgery. Owing to its challenging and technically demanding nature, this incision in acute type A aortic dissection (ATAAD) has rarely been reported. This study aimed to analyze the learning curve of total arch replacement (TAR) with moderate hypothermic circulatory arrest via a single UHS approach, which is necessary to guide the training of surgeons in adopting minimally invasive procedures.Patients and Methods: A total of 202 consecutive patients who were definitively diagnosed with ATAAD between July 2016 and June 2021 were enrolled in this retrospective analysis. Patients were divided into three groups based on cumulative sum plots for circulatory arrest time in chronological order. Perioperative characteristics were compared between the groups.Results: There was significant difference in the circulatory arrest time and cross-clamp time respectively among three groups (39.0 min vs 28.0 min vs 15.0 min, P < 0.001; 104.5 min vs 106.2 min vs 84.1 min, P < 0.001). The ventilation time and first 24-h chest tube drainage were statistically different among groups (35.5 h vs 24.0 h vs 19.0 h, P = 0.031; 220.0 mL vs 192.5 mL vs 125.5 mL, P = 0.043). No other clinical outcome was observed as significant difference.Conclusion: A cardiac surgeon can convert a conventional full sternotomy to a single UHS for TAR after experiencing a learning curve, to ensure patient safety. The mastery of this minimally invasive surgical technique may be beneficial for the prognosis of patients with ATAAD.Keywords: aneurysm, dissecting, cardiac surgical procedures, sternotomy, circulatory arrest, deep hypothermia induced, learning curve

Keywords

• aneurysm
• dissecting
• cardiac surgical procedures
• sternotomy
• circulatory arrest
• deep hypothermia induced
• learning curve