{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T16:19:24Z","timestamp":1773332364914,"version":"3.50.1"},"reference-count":22,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,11,13]],"date-time":"2023-11-13T00:00:00Z","timestamp":1699833600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"American Association","award":["905880"],"award-info":[{"award-number":["905880"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Objective: Minimally invasive approaches are being used increasingly in cardiac surgery and applied in a wider range of operations, including complex aortic procedures. The aim of this study was to examine the safety and feasibility of a partial upper sternotomy approach for isolated elective aortic root replacement (a modified Bentall procedure). Methods: We performed a retrospective analysis of 768 consecutive patients who had undergone isolated Bentall surgery between January 2000 and January 2021 at our institution, with the exclusion of re-operations, endocarditis, acute aortic dissections, and root replacement with major concomitant procedures such as multi-valve or coronary bypass surgery. A total of 98 patients were operated on via partial sternotomy (PS) and were matched 2:1 to 196 patients operated on via full sternotomy (FS). Results: The procedure time was 12 min longer in the PS group (205 min vs. 192.5 min in the FS group, p = 0.002), however, cardiopulmonary bypass and aortic cross-clamp times were comparable between groups. Eight PS-procedures were converted to full sternotomy, predominantly for bleeding complications (n = 6). Re-exploration for acute bleeding was necessary in 11% of the PS group and 4.1% of the FS group (p = 0.02). Five FS patients and none in the PS group required emergency coronary bypass grafting for postoperative coronary obstruction (p = 0.2). PS patients were hospitalized for a significantly shorter period (9.5 days vs. 10.5 days in the FS group, respectively). There were no significant differences regarding in-hospital (p = 0.4) and mid-term mortality (p = 0.73), as well as for other perioperative complications. Conclusions: Performing Bentall operations via partial upper sternotomy is associated with similar perfusion and cross-clamp times, as well as overall mortality, when compared to a full sternotomy approach. A low threshold for conversion to full sternotomy should be accepted if limited access proves insufficient for the handling of intraoperative complications, particularly bleeding.<\/jats:p>","DOI":"10.3390\/life13112204","type":"journal-article","created":{"date-parts":[[2023,11,13]],"date-time":"2023-11-13T08:35:52Z","timestamp":1699864552000},"page":"2204","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Feasibility of Less-Invasive Bentall Surgery: A Real-World Analysis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4412-6337","authenticated-orcid":false,"given":"Antonia","family":"van Kampen","sequence":"first","affiliation":[{"name":"Leipzig Heart Center, University Clinic for Cardiac Surgery, Struempellstr. 39, 04289 Leipzig, Germany"},{"name":"Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian D.","family":"Etz","sequence":"additional","affiliation":[{"name":"Leipzig Heart Center, University Clinic for Cardiac Surgery, Struempellstr. 39, 04289 Leipzig, Germany"},{"name":"Department of Cardiac Surgery, Rostock University Hospital, Schillingallee 35, 18057 Rostock, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josephina","family":"Haunschild","sequence":"additional","affiliation":[{"name":"Leipzig Heart Center, University Clinic for Cardiac Surgery, Struempellstr. 39, 04289 Leipzig, Germany"},{"name":"Department of Cardiac Surgery, Rostock University Hospital, Schillingallee 35, 18057 Rostock, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Misfeld","sequence":"additional","affiliation":[{"name":"Leipzig Heart Center, University Clinic for Cardiac Surgery, Struempellstr. 39, 04289 Leipzig, Germany"},{"name":"Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, 50 Missenden Rd., Camperdown, NSW 2050, Australia"},{"name":"Sydney Medical School, Anderson Stuart Buidling, The University of Sydney, Camperdown, NSW 2050, Australia"},{"name":"Institute of Academic Surgery, Royal Prince Alfred Hospital, 145 Missenden Rd., Camperdown, NSW 2050, Australia"},{"name":"The Baird Institute of Applied Heart and Lung Surgical Research, 100 Carillon Ave., Newtown, NSW 2042, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piroze","family":"Davierwala","sequence":"additional","affiliation":[{"name":"Leipzig Heart Center, University Clinic for Cardiac Surgery, Struempellstr. 39, 04289 Leipzig, Germany"},{"name":"Division of Cardiac Surgery, Toronto General Hospital, University of Toronto, 585 University Ave., Toronto, ON M5G 2N2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergey","family":"Leontyev","sequence":"additional","affiliation":[{"name":"Leipzig Heart Center, University Clinic for Cardiac Surgery, Struempellstr. 39, 04289 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A.","family":"Borger","sequence":"additional","affiliation":[{"name":"Leipzig Heart Center, University Clinic for Cardiac Surgery, Struempellstr. 39, 04289 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1136\/thx.23.4.338","article-title":"A technique for complete replacement of the ascending aorta","volume":"23","author":"Bentall","year":"1968","journal-title":"Thorax"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S64","DOI":"10.1016\/j.jtcvs.2010.07.033","article-title":"The Bentall procedure: Is it the gold standard? A series of 597 consecutive cases","volume":"140","author":"Etz","year":"2010","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1016\/j.athoracsur.2018.07.018","article-title":"Minimally Invasive Approaches to Surgical Aortic Valve Replacement: A Meta-Analysis","volume":"106","author":"Chang","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1093\/ejcts\/ezab373","article-title":"Supracommissural replacement of the ascending aorta and the aortic valve via partial versus full sternotomy-a propensity-matched comparison in a high-volume centre","volume":"61","author":"Haunschild","year":"2021","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.athoracsur.2016.06.008","article-title":"Outcomes of a Less-Invasive Approach for Proximal Aortic Operations","volume":"103","author":"Levack","year":"2017","journal-title":"Ann. Thorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1055\/s-0037-1598196","article-title":"Minimally Invasive Aortic Root Replacement with Valved Conduits through Partial Upper Sternotomy","volume":"66","author":"Hillebrand","year":"2018","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_7","first-page":"326","article-title":"Minimally-invasive aortic root replacement","volume":"2","author":"Byrne","year":"1999","journal-title":"Heart Surg. 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