Aortic arch replacement via mini j-sternotomy: a clinical case

Introduction: for a long time, median sternotomy was considered the “gold standard” in cardiac surgery, providing wide exposure of the operative field. With the advancement of minimally invasive surgical techniques and growing evidence of their long-term effectiveness, there has been a trend towards expanding the indications for these approaches.For complex procedures such as aortic arch replacement, mini J-sternotomy has emerged as a valuable alternative to the standard approach. This incision ensures postoperative chest wall stability, reduces discomfort and pain for patients, and provides superior cosmetic outcomes.
Aim: to evaluate the effectiveness and safety of aortic arch replacement via mini J-sternotomy based on a clinical case.
Materials and methods: at the Department of Cardiovascular Surgery, I.M. Sechenov First Moscow State Medical University (Moscow), a novel approach was tested in the treatment of a patient with aortic arch pathology using mini J-sternotomy. We applied this technique in a 56-year-old patient diagnosed with type I aortic dissection according to M. DeBakey, subacute course. After comprehensive preoperative assessment, the patient underwent aortic valve, ascending aorta, and aortic arch replacement through mini J-sternotomy.
Results: this case demonstrated the technical features and advantages of mini J-sternotomy compared with full median sternotomy for aortic arch replacement: reduced surgical trauma, earlier patient mobilization, lower incidence of respiratory failure, decreased risk of bleeding, reduced postoperative pain, shorter duration of mechanical ventilation, lower rate of postoperative atrial fibrillation, as well as improved cosmetic outcomes. From a financial perspective, this approach was associated with shorter stays in the ICU and specialized ward.

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