Advent of Minimally Invasive Descending Thoracic Aortic Surgery
Objective: Despite advances in minimally invasive cardiac surgery, descending thoracic aortic surgery remains a large and morbid procedure. Endovascular techniques are suitable for high-risk patients, but the reoperation risk is high and the survival benefit is lower than open surgery after 1-2 years in low-risk patients. We present a feasible approach to this difficult problem.
Methods: A minimally invasive descending thoracic aortic aneurysm repair was simulated with a porcine thorax model. Two 5 cm mini-thoracotomies were performed in the 2ndand 5th intercostal spaces. A port for a 10 mm 30° videoscope was placed for added visualization. A simulated aortic graft was sewn into place with shafted instruments. Techniques seen in a typical open procedure were performed, including proximal anastomosis, intercostal artery ostia closure, intercostal island patch placement, and distal anastomosis.
Results: The descending thoracic aortic repair was performed successfully through the mini-thoracotomies. The conduct was sewn similar to an open procedure. Suturing devices were utilized to perform the necessary suturing. This study proved the feasibility of the minimally-invasive approach in a porcine thorax model.
Conclusion: Minimally invasive descending thoracic aortic surgery is possible. The current study demonstrates the feasibility of a descending thoracic aortic repair through two mini-thoracotomies with video guidance in a porcine thorax model. Further research is required. Improvements in suturing technology may facilitate this difficult operation.
Reference: Goodney PP, Travis L, Lucas L, et al. Survival after open versus endovascular thoracic aortic aneurysm repair in an observational study of the Medicare population. Circulation. 2011;124:2661-9.