Helms Florian, Schmack Bastian, Weymann Alexander, Hanke Jasmin Sarah, Natanov Ruslan, Martens Andreas, Ruhparwar Arjang, Popov Aron-Frederik
Division for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany.
Medicina (Kaunas). 2023 Sep 7;59(9):1618. doi: 10.3390/medicina59091618.
Minimally invasive techniques have gained immense importance in cardiovascular surgery. While minimal access strategies for coronary and mitral valve surgery are already widely accepted and often used as standard approaches, the application of minimally invasive techniques is currently expanded towards more complex operations of the ascending aorta as well. In this new and developing field, various techniques have been established and reported ranging from upper hemisternotomy approaches, which allow even extensive operations of the ascending aorta to be performed through a minimally invasive access to sternal sparing thoracotomy strategies, which completely avoid sternal trauma during ascending aorta replacements. All of these techniques place high demands on patient selection, preoperative planning, and practical surgical implementation. Application of these strategies is currently limited to high-volume centers and highly experienced surgeons. This narrative review gives an overview of the currently available techniques with a special focus on the practical execution as well as the advantages and disadvantages of the currently available techniques. The first results demonstrate the practicability and safety of minimally invasive techniques for replacement of the ascending aorta in a well-selected patient population. With success and complication rates comparable to classic full sternotomy, the proof of concept for minimally invasive replacement of the ascending aorta is now achieved.
微创技术在心血管外科中已变得极为重要。虽然冠状动脉和二尖瓣手术的微创策略已被广泛接受并常被用作标准方法，但目前微创技术的应用也正在向升主动脉更复杂的手术扩展。在这个新的和不断发展的领域，已经建立并报道了各种技术，从允许通过微创切口进行甚至广泛的升主动脉手术的上半胸骨切开术方法，到在升主动脉置换期间完全避免胸骨创伤的保留胸骨的胸廓切开术策略。所有这些技术对患者选择、术前规划和实际手术实施都有很高的要求。这些策略的应用目前仅限于大型中心和经验丰富的外科医生。这篇叙述性综述概述了当前可用的技术，特别关注实际操作以及当前可用技术的优缺点。初步结果表明，在精心挑选的患者群体中，微创技术用于升主动脉置换具有可行性和安全性。由于成功率和并发症发生率与经典的全胸骨切开术相当，现在已经实现了升主动脉微创置换的概念验证。
